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Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study

BACKGROUND: The Apfel simplified risk score includes four risk factors: female sex, non-smoking status, postoperative nausea and vomiting or motion sickness history, and postoperative opioid use. The score is calculated preoperatively, so postoperative opioid use must be predicted. We aimed to deter...

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Autores principales: Taylor, Kieran, De Bruyne, Mihika, Li, Christine, Yip, Marcus, Grant, Dominique, Tang, Xinci, Laing, Sarah, Preston, Braden, Chand, Kavinay, De Silva, Anurika, Leslie, Kate, Darvall, Jai N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565679/
https://www.ncbi.nlm.nih.gov/pubmed/37830104
http://dx.doi.org/10.1016/j.bjao.2023.100226
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author Taylor, Kieran
De Bruyne, Mihika
Li, Christine
Yip, Marcus
Grant, Dominique
Tang, Xinci
Laing, Sarah
Preston, Braden
Chand, Kavinay
De Silva, Anurika
Leslie, Kate
Darvall, Jai N.
author_facet Taylor, Kieran
De Bruyne, Mihika
Li, Christine
Yip, Marcus
Grant, Dominique
Tang, Xinci
Laing, Sarah
Preston, Braden
Chand, Kavinay
De Silva, Anurika
Leslie, Kate
Darvall, Jai N.
author_sort Taylor, Kieran
collection PubMed
description BACKGROUND: The Apfel simplified risk score includes four risk factors: female sex, non-smoking status, postoperative nausea and vomiting or motion sickness history, and postoperative opioid use. The score is calculated preoperatively, so postoperative opioid use must be predicted. We aimed to determine whether anaesthetists can predict patients' postoperative opioid use and dose. METHODS: Specialist anaesthetists from eight hospitals preoperatively predicted opioid use and dose in the post-anaesthesia care unit (PACU) and for the first 24 h postoperatively, which was compared with actual opioid use and dose. Opioid doses were converted to oral morphine equivalents (MEQ). Correlations between predicted and actual opioid use and dose were analysed with Spearman's rho and linear regression. RESULTS: A total of 487 anaesthetist–patient pairs were included. Anaesthetists overpredicted opioid use (398 [82%] predicted vs 251 [52%] actual patients requiring opioids in the PACU; 396 [81%] predicted vs 291 [60%] actual in the first 24 h) (Spearman's rho [95% confidence interval] 0.24 [0.16–0.33], P<0.001 in the PACU; 0.36 [0.28–0.44], P<0.001 in the first 24 h). Anaesthetists also overpredicted opioid dose (median [inter-quartile range] 12 [8–20] mg predicted MEQ vs 4 [0–18] mg actual MEQ in the PACU; 32 [18–60] mg vs 24 [0–65] mg MEQ in the first 24 h) (Spearman's rho 0.21 [0.13–0.29], P<0.001 in the PACU; 0.53 [0.40–0.60], P<0.001 in the first 24 h). CONCLUSIONS: Specialist anaesthetists cannot accurately predict opioid use or dose in the PACU or the first 24 postoperative hours. The Apfel risk criterion for postoperative opioid use may be inaccurate in clinical practice.
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spelling pubmed-105656792023-10-12 Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study Taylor, Kieran De Bruyne, Mihika Li, Christine Yip, Marcus Grant, Dominique Tang, Xinci Laing, Sarah Preston, Braden Chand, Kavinay De Silva, Anurika Leslie, Kate Darvall, Jai N. BJA Open Original Research Article BACKGROUND: The Apfel simplified risk score includes four risk factors: female sex, non-smoking status, postoperative nausea and vomiting or motion sickness history, and postoperative opioid use. The score is calculated preoperatively, so postoperative opioid use must be predicted. We aimed to determine whether anaesthetists can predict patients' postoperative opioid use and dose. METHODS: Specialist anaesthetists from eight hospitals preoperatively predicted opioid use and dose in the post-anaesthesia care unit (PACU) and for the first 24 h postoperatively, which was compared with actual opioid use and dose. Opioid doses were converted to oral morphine equivalents (MEQ). Correlations between predicted and actual opioid use and dose were analysed with Spearman's rho and linear regression. RESULTS: A total of 487 anaesthetist–patient pairs were included. Anaesthetists overpredicted opioid use (398 [82%] predicted vs 251 [52%] actual patients requiring opioids in the PACU; 396 [81%] predicted vs 291 [60%] actual in the first 24 h) (Spearman's rho [95% confidence interval] 0.24 [0.16–0.33], P<0.001 in the PACU; 0.36 [0.28–0.44], P<0.001 in the first 24 h). Anaesthetists also overpredicted opioid dose (median [inter-quartile range] 12 [8–20] mg predicted MEQ vs 4 [0–18] mg actual MEQ in the PACU; 32 [18–60] mg vs 24 [0–65] mg MEQ in the first 24 h) (Spearman's rho 0.21 [0.13–0.29], P<0.001 in the PACU; 0.53 [0.40–0.60], P<0.001 in the first 24 h). CONCLUSIONS: Specialist anaesthetists cannot accurately predict opioid use or dose in the PACU or the first 24 postoperative hours. The Apfel risk criterion for postoperative opioid use may be inaccurate in clinical practice. Elsevier 2023-10-06 /pmc/articles/PMC10565679/ /pubmed/37830104 http://dx.doi.org/10.1016/j.bjao.2023.100226 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research Article
Taylor, Kieran
De Bruyne, Mihika
Li, Christine
Yip, Marcus
Grant, Dominique
Tang, Xinci
Laing, Sarah
Preston, Braden
Chand, Kavinay
De Silva, Anurika
Leslie, Kate
Darvall, Jai N.
Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
title Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
title_full Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
title_fullStr Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
title_full_unstemmed Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
title_short Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
title_sort anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565679/
https://www.ncbi.nlm.nih.gov/pubmed/37830104
http://dx.doi.org/10.1016/j.bjao.2023.100226
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