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Anesthetic Induction Overdose Among Elderly Surgical Patients

老年手术患者麻醉诱导过量

基本信息

批准号：
10376806
负责人：
ROBERT SCHONBERGER
金额：
$ 42.9万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10376806
关键词：
Acute Acute Renal Failure with Renal Papillary Necrosis Adherence Affect Age American Anesthesia procedures Anesthesiology Anesthetics Attention Blood Pressure Cardiac Caring Characteristics Clinical Clinical Data Complication Consultations Data Databases Dose Elderly Failure Feedback Future Health Care Costs Healthcare Hemorrhage Hospital Costs Hospital Mortality Hypotension Hypotensives Individual Injury to Kidney Inpatients Institution Intervention Leadership Liquid substance Measures Medicare Medicare claim Morbidity - disease rate Myocardial Infarction Operative Surgical Procedures Outcome Overdose Patients Pattern Perioperative Perioperative complication Persons Polypharmacy Population Postoperative Period Prevalence Preventive measure Professional Organizations Provider Public Health Recommendation Records Risk Safety Sampling Site Surgical incisions System Testing Work aging population base comorbidity data registry demographics design feasibility testing frailty health care service utilization high risk human old age (65+)improved member mortality older patient patient population patient subsets pressure primary outcome secondary outcome surgery outcome tool

项目摘要

1 Patients age≥65 account for nearly 40% of annual surgeries, and this proportion will increase as 2 the population ages. These older patients have more perioperative complications - e.g. acute 3 kidney injury (AKI) and myocardial infarction (MI) - and the complication rate increases by 2-4 4 fold after age 80. Anesthesia induction requirements are known to decrease significantly with 5 age. We believe perioperative complications in older surgical patients result in part from 6 a failure among anesthesiologists to follow FDA guidance to reduce induction anesthetic 7 doses for these patients – a population with polypharmacy, frailty, decreased functional 8 reserve, and multiple interacting comorbidities. Severe hypotension (mean arterial 9 pressure<55mmHg) during surgery - even for a few brief minutes - increases risk of AKI by 10 18%, and MI by 30%, highlighting the importance of preventive measures to reduce hypotensive 11 episodes. Our multi-center pilot data indicates that anesthetic induction dose substantially 12 exceeds FDA guidance for many patients age ≥65 and that high induction doses often provoke 13 hypotension among these elderly patients. Hypotension during surgery can have multiple 14 causes, but when provoked by induction anesthetic overdose, it is modifiable. We propose to 15 combine data from the Multicenter Perioperative Outcomes Group (MPOG) database – 16 containing over 9.3 million anesthetic records from 44 centers - with Medicare data to, 1) identify 17 the prevalence of deviation from FDA induction dosing guidance nationwide; 2) test the 18 contribution of anesthetic induction overdose to perioperative complications; and 3) feasibility 19 test a pilot, quality improvement (QI) tool concerning deviation from FDA guidance on induction 20 dosing for the elderly. Among patients age≥65, and separately among those age≥80, our aims 21 are: Aim 1: To measure provider variability and identify outliers in FDA-adherent anesthetic 22 induction practice; Aim 2: Measure the association of anesthetic induction overdose to, a) 23 clinically meaningful hypotension, and b) subsequent postoperative morbidity and mortality; and 24 Aim 3: Develop and feasibility test a QI feedback tool – leveraging an established MPOG 25 platform - focused on deviation from FDA guidance for induction dosing of the elderly. 26 Public Health Significance: Demonstrating patterns of anesthetic overdose in excess of FDA 27 guidance and the consequences of this care failure among vulnerable subsets of patients, we 28 will highlight a clear target – FDA-adherent age-adjustment of anesthesia induction dose - to 29 make healthcare safer for older patients. The proposed analyses will support the testing of an 30 intervention to increase FDA-adherent anesthesia induction dosing for older Americans.

1名≥65岁的患者占年度手术的近40%，这一比例将随着 2人口老龄化。这些老年患者有更多的围手术期并发症--例如急性 3肾损伤(AKI)和心肌梗死(MI)-并发症发生率增加2-4 80岁后翻4倍。已知麻醉诱导需求显著减少 5岁。我们认为老年手术患者围手术期并发症的部分原因是 6麻醉师未能遵循FDA的指导减少诱导麻醉剂为这些患者提供7剂--多药、虚弱、功能减退的人群 8后备，多种互动并存。严重低血压(平均动脉手术中压力为55毫米汞柱)，即使是很短的几分钟，也会增加AKI的风险 1018%，MI增加30%，强调预防措施的重要性，以降低低血压共11集。我们的多中心飞行员数据表明，麻醉剂诱导剂量很大对于许多年龄在≥65岁的患者来说，12岁超过了食品和药物管理局的指导方针，高诱导剂量经常会引发 13例老年患者出现低血压。手术中的低血压可有多个 14个原因，但当由诱导麻醉剂过量引起时，它是可以改变的。我们建议 15结合来自多中心围术期结局小组(MPOG)数据库的数据- 16包含来自44个中心的930多万份麻醉记录-使用Medicare数据来识别，1) 17全国范围内偏离FDA诱导剂量指南的流行率；2)测试 18麻醉诱导过量对围手术期并发症的贡献；3)可行性 19测试试点、质量改进(QI)工具，该工具与FDA的诱导指南存在偏差老年人服用20剂。在≥65岁的患者中，以及在≥80岁的患者中，我们的目标是 21个是：目标1：测量提供者的可变性并确定FDA依从性麻醉剂中的异常值 22诱导练习；目标2：测量麻醉诱导过量与，a) 23有临床意义的低血压，以及b)随后的术后发病率和死亡率； 24目标3：开发和可行性测试QI反馈工具--利用已建立的MPOG 25平台-专注于偏离FDA对老年人诱导剂量的指导。 26公共卫生意义：麻醉剂过量超过FDA的示范模式 27在脆弱的患者亚群中的指导和这种护理失败的后果，我们 28将突出一个明确的目标-FDA-遵守年龄-调整麻醉诱导剂量 29使老年患者的医疗保健更安全。拟议的分析将支持对 30采取干预措施，增加美国老年人遵守FDA的麻醉诱导剂量。