Prevalence of Meperidine Use in Older Surgical Patients

Kornitzer, Benjamin S.; Manace, Leslie C.; Fischberg, Daniel; Leipzig, Rosanne M.

doi:10.1001/archsurg.141.1.76

Cited by 16 publications

(13 citation statements)

References 40 publications

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“…Variation in PIM use according to physician specialty has also been documented in participants admitted with medical diagnoses because cardiologists and internists are more likely to prescribe PIMS than geriatricians 10 . Smaller studies examining meperidine use in hospitalized people aged 65 and older found that those undergoing surgery were seven times as likely as medical patients to receive meperidine 15 …”

Section: Discussionmentioning

confidence: 99%

Inappropriate Medication Use in Older Adults Undergoing Surgery: A National Study

Finlayson¹,

Maselli²,

Steinman

et al. 2011

J. Am. Geriatr. Soc.

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Objectives To determine the prevalence and factors associated with use of potentially inappropriate medications (PIMs) in elderly surgical patients. Design Retrospective cohort study. Setting 379 acute care hospitals participating in the nationally representative Perspective database (2006-2008). Participants Individuals age 65 and older undergoing major inpatient gastrointestinal, gynecologic, urologic, and orthopedic surgery (n=272,351). Measurements Medications were classified as PIMs using previously published criteria. Information about patient and provider characteristics and administration of PIMs was obtained from hospital discharge file data. We used logistic regression techniques to examine factors associated with use of PIMsin the perioperative period. Results 272,351 patients aged 65 or older underwent one of our target surgical procedures, and one quarter of patients received at least one PIM during their surgical admission. Meperidine was the most frequently prescribed PIM (37,855, 14% of patients). In adjusted analysis, PIM use was less likely as age advanced (adjusted OR 0.98 per year of age, 95%CI 0.97-0.98) and among men (adjusted OR 0.83, 95%CI 0.81-0.85). PIMs were most likely to be prescribed to patients cared for by an orthopedic surgeon (adjusted OR 1.22, 95%CI 1.08-1.40 v. general surgeons). Compared to patients undergoing surgery in the Northeast, patients in the West and South were more likely to receive a PIM (adjusted OR 1.79, 95%CI 1.02-3.16 and adjusted OR 2.24, 95%CI 1.38-3.64, respectively). Conclusions Receipt of PIMs in elderly surgical patients is common and varies widely across providers, geographic regions, and by patient characteristics. Interventions aimed at reducing the use of PIMs in the perioperative period should be considered in quality improvement efforts.

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Section: Discussionmentioning

confidence: 99%

Inappropriate Medication Use in Older Adults Undergoing Surgery: A National Study

Finlayson¹,

Maselli²,

Steinman

et al. 2011

J. Am. Geriatr. Soc.

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“…A population-based study indicated that patients aged 80 years and older who received care in clinics tended to be prescribed potentially inappropriate medications (30). Previous studies also reported that pethidine was administered to only approximately one in eigth older surgical patients (10), mainly due to the greater likelihood that the elderly would experience side effects from pethidine, which may have affected physician prescribing behavior (31). The increased number and proportion of elderly pethidine users in recent years noted in our study warrants further intervention to effectively reduce the use of pethidine in this vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

“…Valano et al (29) used a cross-sectional study design to demonstrate that adherence to analgesic treatment guidelines was higher in large hospitals than in medium- and small-sized hospitals. A recent study also reported that pethidine was prescribed to 7.6% and 4.3% of all study patients at a large private tertiary care teaching hospital and a smaller academically affiliated Veteran's Affairs medical center, respectively, but the number of doses administered was similar at both sites (10). The variation in the number of pethidine doses prescribed to patients treated in hospitals with different accreditation levels may reflect the different severity of diseases that required different strategies to manage pain.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the clinical guidelines that have been issued against pethidine use in many nations (9), it continues to be used in many parts of the world, including Taiwan (10-13). One of the arguments supporting the use of pethidine is that concurrent analgesics given with pethidine can achieve adequate analgesia without causing adverse effects in patients with renal failure (14).…”

Section: Introductionmentioning

confidence: 99%

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Trends and characteristics of pethidine use in Taiwan: a six-year-long survey

Pan¹,

Li²,

Lin³

et al. 2012

Clinics

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OBJECTIVES:To investigate the trends and characteristics of pethidine prescriptions and users in Taiwan from 2002 to 2007.METHOD:All pethidine users (n = 3,301,136) in Taiwan from 2002 to 2007 were linked to National Health Insurance claims to identify pethidine prescriptions. We examined the trends in pethidine user prevalence and the proportion of pethidine prescriptions according to health care characteristics. A logistic regression model was used to compare patient demographics and health care characteristics associated with pethidine prescriptions between 2002 and 2007.RESULTS:Despite the decline in the number of pethidine users and prescriptions over the six-year period, more than half a million people were prescribed pethidine annually. In fact, an increasing proportion of pethidine prescriptions were observed in clinics, outpatient settings, and patients who had both operations and cancer diagnoses. Pethidine prescriptions were mostly associated with a non-operation status without a cancer diagnosis (>60%). However, approximately 10% of the total pethidine prescriptions were found in patients with a cancer diagnosis but no operation. Compared to those in 2002, pethidine prescriptions in 2007 were more likely to be found in people 80 years or older, rural residents, patients from clinics, outpatient settings and operation patients with cancer diagnoses.CONCLUSIONS:A population-based survey in Taiwan demonstrated decreasing consumption of pethidine from 2002 to 2007; however, an increased proportion of prescriptions in certain health care settings was observed. In addition, 10% of the pethidine prescriptions were for cancer patients without operations. These cases need further evaluation for the determination of appropriate pethidine use.

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“…Despite the wealth of documentation in the primary literature outlining the dangers of meperidine, it continues to be prescribed as a first-line agent, particularly by surgeons. 1 We outline two different approaches to meeting this challenge, both of which were implemented at the Memorial Healthcare System, a 1300-bed, four-hospital system in Fort Lauderdale, Florida.…”

mentioning

confidence: 99%