Association between intraoperative opioid administration and 30-day readmission: a pre-specified analysis of registry data from a healthcare network in New England

Abstract

High intraoperative opioid dose is a modifiable anaesthetic factor that varies in the practice of individual anaesthetists and affects postoperative outcomes. Conservative standards for intraoperative opioid dosing may reduce the risk of postoperative readmission, particularly in ambulatory surgery.

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study

“…Furthermore, we considered surgical complexity as quantified by the procedural severity score . Intra‐operative candidate variables were selected a priori based on recent literature, biological plausibility and clinical reasoning and included: desaturation (S p O 2 ≤ 90%) 5 min after tracheal intubation ; duration of surgery; median fraction of inspired oxygen (F I O 2 ) ; noradrenaline equivalent dose of vasopressors; dose of neuromuscular blocking agents (NMBA) (expressed as multiples of NMBA dose needed to reduce twitch height by 95%) ; fluid volume ; oral morphine equivalent dose ; total administered fentanyl dose; intra‐operative transfusion of packed red blood cells; use of volatile anaesthetic agents ; and the absence of lung‐protective ventilation (defined as driving pressure [plateau pressure – positive end‐expiratory pressure (PEEP)] > 15 mmHg) .…”

Persistent Opioid Use Among the Elderly After Lung Resection: A SEER-Medicare Study

“…10 Although persistent opioid use may have a role for some patients to allow function and maintain quality of life, opioid use has been shown to be associated with several deleterious aspects of health. These include overdose, 17 poor compliance with treatment recommendations, 18 operative morbidity and mortality, [1][2][3][4][5][6] and risk of subsequent opioid dependence for family members, 19 among many others.…”

“…However, postoperative morbidity related to opioid therapy can be severe. [1][2][3][4][5][6] Furthermore, chronic use may develop, which is helping to fuel the opioid crisis. 7 From 2001 to 2016, opioid-related deaths in the United States increased 345%.…”

The association of early postoperative desaturation in the operating theatre with hospital discharge to a skilled nursing or long‐term care facility

“…In this study, we present an easy to assess parameter, namely early postoperative desaturation in the operating theatre, which can be utilised to study interventions that may predict safe tracheal extubation. There remain several areas where wide variation exists between providers, including in opioid administration, neostigmine dosing, F I O 2 titration and use of lung‐protective ventilation . Our data show that there is substantial anaesthesia provider variability in the incidence of early postoperative desaturation as well.…”

“…The model also included factors related to the surgical procedure: duration of surgery; surgical speciality; duration of intra‐operative hypotension (defined as mean arterial pressure < 55 mmHg); emergency surgery; Procedural Severity Score for morbidity ; and year of surgery. Additionally, we adjusted for several anaesthetic‐related factors: packed red blood cell units transfused; intravenous fluid volume administration; lung‐protective ventilation (defined as median positive end‐expiratory pressure ≥ 5 cmH 2 O and median plateau pressure ≤ 16 cmH 2 O); vasopressor equivalent dose ; age‐adjusted effective dose of inhalational anaesthetics; use of neuraxial anaesthesia; intra‐operative long‐acting opioid dose equivalent (morphine, hydromorphone, meperidine, methadone); intra‐operative short‐acting opioid dose equivalent ; NMBA dose (measured as multiples of NMBA dose needed to reduce twitch height by 95%) ; neostigmine dose; and median intra‐operative fraction of inspired oxygen (F I O 2 ). Variables were categorised based on their accordance with the linearity hypothesis (online supporting information S1).…”