PDF(Pubmed)
Abstract：
BACKGROUND: Perioperative opioid use has been associated with adverse clinical outcomes. Additionally, opioid disposal carries significant costs, due to the waste of pharmaceutical products and the time needed by skilled labor to report the waste. In this study, we aimed to estimate costs and predict factors of opioid-associated intraoperative product waste, as well as to evaluate whether higher intraoperative opioid doses are associated with increased risk of adverse postoperative outcomes.
METHODS: We included 170,607 patients undergoing general anesthesia and receiving intraoperative fentanyl, hydromorphone, or morphine at Beth Israel Deaconess Medical Center, Boston, MA, USA, between January 2010 and June 2020. We estimated product waste-associated costs based on various opioid syringe sizes and determined predictors of opioid waste. Further, we evaluated whether higher opioid doses were associated with postoperative adverse events according to the severity-indexed, incident report-based medication error-reporting program classification. The primary outcome included post-extubation desaturation, postoperative nausea or vomiting, or postoperative somnolence or sedation.
RESULTS: The use of the smallest syringe sizes (50 mcg for fentanyl, 0.2 mg for hydromorphone, and 2 mg for morphine) resulted in the lowest product waste-associated costs. The main predictor of opioid waste was the administration of more than one intraoperative opioid (adjusted odds ratio [aOR] = 7.64, 95% CI 7.40-7.89, P < 0.001). Intraoperative doses of fentanyl > 50-100 mcg (aOR = 1.17 [1.10-1.25], P < 0.001, adjusted risk difference [ARD] 2%) and > 100 mcg (aOR = 1.24 [1.16-1.33], P < 0.001, ARD 3%), hydromorphone > 1 mg (aOR = 1.13 [1.06-1.20], P < 0.001, ARD 2%), and morphine > 2-4 mg (aOR = 1.26 [1.02-1.56], P = 0.04, ARD 3%) and > 4 mg (aOR = 1.45 [1.18-1.77], P < 0.001, ARD 5%) were associated with higher risk of the primary outcome.
CONCLUSIONS: Smaller syringe sizes of intraoperative opioids may help to reduce product waste and associated costs, as well postoperative adverse events through utilization of lower intraoperative opioid doses.
METHODS: We included 170,607 patients undergoing general anesthesia and receiving intraoperative fentanyl, hydromorphone, or morphine at Beth Israel Deaconess Medical Center, Boston, MA, USA, between January 2010 and June 2020. We estimated product waste-associated costs based on various opioid syringe sizes and determined predictors of opioid waste. Further, we evaluated whether higher opioid doses were associated with postoperative adverse events according to the severity-indexed, incident report-based medication error-reporting program classification. The primary outcome included post-extubation desaturation, postoperative nausea or vomiting, or postoperative somnolence or sedation.
RESULTS: The use of the smallest syringe sizes (50 mcg for fentanyl, 0.2 mg for hydromorphone, and 2 mg for morphine) resulted in the lowest product waste-associated costs. The main predictor of opioid waste was the administration of more than one intraoperative opioid (adjusted odds ratio [aOR] = 7.64, 95% CI 7.40-7.89, P < 0.001). Intraoperative doses of fentanyl > 50-100 mcg (aOR = 1.17 [1.10-1.25], P < 0.001, adjusted risk difference [ARD] 2%) and > 100 mcg (aOR = 1.24 [1.16-1.33], P < 0.001, ARD 3%), hydromorphone > 1 mg (aOR = 1.13 [1.06-1.20], P < 0.001, ARD 2%), and morphine > 2-4 mg (aOR = 1.26 [1.02-1.56], P = 0.04, ARD 3%) and > 4 mg (aOR = 1.45 [1.18-1.77], P < 0.001, ARD 5%) were associated with higher risk of the primary outcome.
CONCLUSIONS: Smaller syringe sizes of intraoperative opioids may help to reduce product waste and associated costs, as well postoperative adverse events through utilization of lower intraoperative opioid doses.
摘要：
背景：围手术期使用阿片类药物与不良临床结局相关。此外,阿片类药物处置会带来巨大的成本，由于药品的浪费和熟练劳动力报告浪费所需的时间。在这项研究中,我们的目的是估计成本和预测阿片类药物相关的术中产品废物的因素，以及评估术中阿片类药物剂量增加是否与术后不良结局风险增加相关。
方法：我们包括170,607例接受全身麻醉并接受术中芬太尼的患者，氢吗啡酮,或者贝丝以色列女执事医疗中心的吗啡,波士顿,MA,美国,2010年1月至2020年6月。我们根据各种阿片类药物注射器的尺寸和确定阿片类药物废物的预测因素估算了与产品废物相关的成本。Further,我们根据严重程度指数评估了更高的阿片类药物剂量是否与术后不良事件相关,基于事件报告的药物错误报告程序分类。主要结果包括拔管后去饱和，术后恶心或呕吐，或术后嗜睡或镇静。
结果：使用最小的注射器尺寸（芬太尼为50mcg，氢吗啡酮为0.2毫克，吗啡和2mg）导致最低的产品废物相关成本。阿片类药物废物的主要预测因素是术中使用一种以上阿片类药物（校正比值比[aOR]=7.64，95％CI7.40-7.89，P<0.001）。术中芬太尼剂量>50-100mcg（aOR=1.17[1.10-1.25]，P<0.001，调整后的风险差异[ARD]2%）和>100mcg（aOR=1.24[1.16-1.33]，P<0.001，ARD3%)，氢吗啡酮>1毫克(aOR=1.13[1.06-1.20]，P<0.001，ARD2%)，吗啡>2-4毫克(aOR=1.26[1.02-1.56]，P=0.04，ARD3%）和>4毫克（aOR=1.45[1.18-1.77]，P<0.001，ARD5％）与主要结局的较高风险相关。
结论：术中阿片类药物的较小注射器尺寸可能有助于减少产品浪费和相关成本，以及术后不良事件通过使用较低的术中阿片类药物剂量。
方法：我们包括170,607例接受全身麻醉并接受术中芬太尼的患者，氢吗啡酮,或者贝丝以色列女执事医疗中心的吗啡,波士顿,MA,美国,2010年1月至2020年6月。我们根据各种阿片类药物注射器的尺寸和确定阿片类药物废物的预测因素估算了与产品废物相关的成本。Further,我们根据严重程度指数评估了更高的阿片类药物剂量是否与术后不良事件相关,基于事件报告的药物错误报告程序分类。主要结果包括拔管后去饱和，术后恶心或呕吐，或术后嗜睡或镇静。
结果：使用最小的注射器尺寸（芬太尼为50mcg，氢吗啡酮为0.2毫克，吗啡和2mg）导致最低的产品废物相关成本。阿片类药物废物的主要预测因素是术中使用一种以上阿片类药物（校正比值比[aOR]=7.64，95％CI7.40-7.89，P<0.001）。术中芬太尼剂量>50-100mcg（aOR=1.17[1.10-1.25]，P<0.001，调整后的风险差异[ARD]2%）和>100mcg（aOR=1.24[1.16-1.33]，P<0.001，ARD3%)，氢吗啡酮>1毫克(aOR=1.13[1.06-1.20]，P<0.001，ARD2%)，吗啡>2-4毫克(aOR=1.26[1.02-1.56]，P=0.04，ARD3%）和>4毫克（aOR=1.45[1.18-1.77]，P<0.001，ARD5％）与主要结局的较高风险相关。
结论：术中阿片类药物的较小注射器尺寸可能有助于减少产品浪费和相关成本，以及术后不良事件通过使用较低的术中阿片类药物剂量。
