Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study
Kieran Taylor,
Mihika De Bruyne,
Christine Li,
Marcus Yip,
Dominique Grant,
Xinci Tang,
Sarah Laing,
Braden Preston,
Kavinay Chand,
Anurika De Silva,
Kate Leslie,
Jai N. Darvall
Affiliations
Kieran Taylor
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Mihika De Bruyne
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Christine Li
Department of Anaesthesia and Pain Medicine, Footscray Hospital, Melbourne, Australia
Marcus Yip
Department of Anaesthesia, St Vincent’s Hospital, Melbourne, Australia
Dominique Grant
Department of Anaesthesia, Austin Hospital, Melbourne, Australia
Xinci Tang
Department of Anaesthesia, Northern Hospital, Melbourne, Australia
Sarah Laing
Department of Anaesthesia, Ballarat Base Hospital, Ballarat, Australia
Braden Preston
Department of Anaesthesia, Northeast Health Wangaratta, Wangaratta, Australia
Kavinay Chand
Department of Anaesthesia, Goulburn Valley Health, Shepparton, Australia
Anurika De Silva
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Monash University, Melbourne, Australia; Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, Australia
Kate Leslie
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
Jai N. Darvall
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia; Corresponding author. Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.
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.
