Pain and Therapy (Jan 2024)

Intraoperative Opioid Waste and Association of Intraoperative Opioid Dose with Postoperative Adverse Outcomes: A Hospital Registry Study

  • Simone Redaelli,
  • Aiman Suleiman,
  • Dario von Wedel,
  • Sarah Ashrafian,
  • Ricardo Munoz-Acuna,
  • Guanqing Chen,
  • Mitra Khany,
  • Catriona Stewart,
  • Nikolai Ratajczak,
  • John Hertig,
  • Sarah Nabel,
  • Maximilian S. Schaefer,
  • Satya Krishna Ramachandran

DOI
https://doi.org/10.1007/s40122-023-00574-2
Journal volume & issue
Vol. 13, no. 2
pp. 211 – 225

Abstract

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Abstract Introduction 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 50–100 mcg (aOR = 1.17 [1.10–1.25], P 100 mcg (aOR = 1.24 [1.16–1.33], P 1 mg (aOR = 1.13 [1.06–1.20], P 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. Conclusion 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.

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