Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33997
Title: Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study.
Austin Authors: 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
Affiliation: Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.;School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.;School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Anaesthesia and Pain Medicine, Footscray Hospital, Melbourne, Australia.
Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia.
Anaesthesia
Department of Anaesthesia, Northern Hospital, Melbourne, Australia.
Department of Anaesthesia, Ballarat Base Hospital, Ballarat, Australia.
Department of Anaesthesia, Northeast Health Wangaratta, Wangaratta, Australia.
Department of Anaesthesia, Goulburn Valley Health, Shepparton, Australia.
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.
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.
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.;Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Issue Date: Dec-2023
Date: 2023
Publication information: BJA Open 2023-12; 8
Abstract: 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. 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. 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). 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33997
DOI: 10.1016/j.bjao.2023.100226
ORCID: 
Journal: BJA Open
Start page: 100226
PubMed URL: 37830104
ISSN: 2772-6096
Type: Journal Article
Subjects: anaesthesia
opioid
postoperative nausea and vomiting
risk prediction
risk score
Appears in Collections:Journal articles

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