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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 年龄≥65 岁的患者占每年手术量的近 40%，并且这一比例将随着年龄的增长而增加 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 岁后增加 4 倍。众所周知，麻醉诱导需求随着年龄的增长而显着降低 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 麻醉医师未能遵循 FDA 减少诱导麻醉的指南这些患者接受 7 剂剂量——经常服用多种药物、身体虚弱、功能下降的人群 8 保留，以及多种相互作用的合并症。严重低血压（平均动脉血压 9 压力<55mmHg）在手术期间 - 即使是短暂的几分钟 - 也会增加 AKI 的风险 10 18%，MI 30%，强调了预防措施降低低血压的重要性 11集。我们的多中心试点数据表明麻醉诱导剂量显着 12 超出了 FDA 对许多年龄≥65 岁患者的指导，高诱导剂量经常会引起 13名老年患者出现低血压。手术期间的低血压可能有多种原因 14 种原因，但当诱导麻醉剂过量引起时，这是可以改变的。我们建议 15 结合多中心围手术期结果组 (MPOG) 数据库的数据 – 16 包含来自 44 个中心的超过 930 万份麻醉记录 - 医疗保险数据用于：1) 识别 17 全国范围内偏离 FDA 诱导剂量指南的情况； 2）测试 18 麻醉诱导过量对围手术期并发症的影响； 3）可行性 19 测试试点质量改进 (QI) 工具，了解与 FDA 诱导指南的偏差老年人20服药。在年龄≥65岁的患者中，以及在年龄≥80岁的患者中，我们的目标 21 项是：目标 1：衡量提供者的变异性并识别 FDA 规定的麻醉剂中的异常值 22 入门练习；目标 2：测量麻醉诱导过量与 a) 的关联 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；和 24 目标 3：利用已建立的 MPOG 开发 QI 反馈工具并进行可行性测试 25 平台 - 重点关注与 FDA 对老年人诱导给药指南的偏差。 26 公共卫生意义：展示超过 FDA 规定的麻醉剂过量使用模式 27 弱势患者亚群中的指导和这种护理失败的后果，我们 28 日将强调一个明确的目标——FDA 规定的麻醉诱导剂量年龄调整—— 29 让老年患者的医疗保健更加安全。拟议的分析将支持测试 30 增加美国老年人遵守 FDA 规定的麻醉诱导剂量的干预措施。