Anesthesia Journal - Variations in the Use of Perioperative Multimodal Analgesic Therapy PDF
Karim S. Ladha, M.D., M.Sc.; Elisabetta Patorno, M.D.,
Dr.P.H.; Krista F. Huybrechts, M.S., Ph.D.; Jun Liu, M.D., M.S.; James P.
Rathmell, M.D.; Brian T. Bateman, M.D., M.Sc.
Abstract
Background: Practice guidelines for perioperative pain
management recommend that multimodal analgesic therapy should be used for all
postsurgical patients. However, the proportion of patients who actually receive
this evidence-based approach is unknown. The objective of this study was to
describe hospital-level patterns in the utilization of perioperative multimodal
analgesia.
Methods: Data for the study were obtained from the Premier
Research Database. Patients undergoing below-knee amputation, open lobectomy,
total knee arthroplasty, and open colectomy between 2007 and 2014 were included
in the analysis. Patients were considered to have multimodal therapy if they
received one or more nonopioid analgesic therapies. Mixed-effects logistic
regression models were used to estimate the hospital-specific frequency of
multimodal therapy use while adjusting for the case mix of patients and
hospital characteristics and accounting for random variation.
Results: The cohort consisted of 799,449 patients who
underwent a procedure at 1 of 315 hospitals. The mean probability of receiving
multimodal therapy was 90.4%, with 95% of the hospitals having a predicted probability
between 42.6 and 99.2%. A secondary analysis examined whether patients received
two or more nonopioid analgesics, which gave an average predicted probability
of 54.2%, with 95% of the hospitals having a predicted probability between 9.3
and 93.2%.
Conclusions: In this large nationwide sample of surgical
admissions in the United States, the authors observed tremendous variation in
the utilization of multimodal therapy not accounted for by patient or hospital
characteristics. Efforts should be made to identify why there are variations in
the use of multimodal analgesic therapy and to promote its adoption in
appropriate patients.
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