Variation in Intraoperative Opioid Administration by Patient, Clinician, and Hospital Contribution
Authors' conclusion
In this cohort study, clinician-, hospital-, and patient-level factors had important contributions to substantial variation of opioid administrations during surgical procedures.
Study context
- Population
- Elective surgical procedures in patients without ambulatory opioid prescriptions or use history, 46 US hospitals, 2014–2020surgical procedures, 46 hospitals
- Participants
- 1,011,268 procedures
- Outcome
- Rate of intraoperative opioid administration (oral morphine equivalents (OMEs) normalized to weight and case duration); attributable variance by patient, clinician and hospital levels (adjusted intraclass correlations (ICCs))
Methodological detailsmulticentre, national quality collaborative database, hierarchical variance analysis, Data analyzed January 2022 to July 2023
- Multicentre
- National quality collaborative database
- Hierarchical variance analysis
- Data analyzed January 2022 to July 2023
Main finding
As reported in the abstract
- Mean (SD) rate of intraoperative opioid administration, OME/kg/h
- 0.3 [0.2]
- Clinician and hospital levels together contributed to variability across all analgesic and surgical categories
- 20% or more
- ICC, patient
- 0.57-0.79
- ICC, anesthesiologist
- 0.04-0.22
- ICC, hospital
- 0.09-0.26
- Lowest anesthesiologist + hospital ICC combination (opioid only: 0.12 anesthesiologist, 0.09 hospital)
- 0.21
Observational data: associations, not effects.
Further findings
Adjusted mean (square error mean) administration by surgical category
- Adjusted mean (square error mean) administration by surgical category: highest for cardiac, lowest for orthopedic knee; adjusted for patient and surgical characteristics
Variation, 95th vs fifth percentile of opioid administration
- Among anesthesiologists (surgical category range, 2.7-fold to 7.7-fold)
- 3.3-fold
- Among surgeons (surgical category range, 3.4-fold to 8.0-fold)
- 4.3-fold
- Among hospitals (surgical category range, 2.2-fold to 4.3-fold)
Reduction in administration with peripheral and neuraxial analgesic techniques
- Orthopedic hip, peripheral
- 51.6% (95% CI, 51.4%-51.8%)
- Orthopedic hip, neuraxial
- 60.7% (95% CI, 60.5%-60.9%)
- Knee, peripheral
- 48.3% (95% CI, 48.0%-48.5%)
- Knee, neuraxial
- 60.9% (95% CI, 60.7%-61.1%)
- Other surgical categories, peripheral, mean [SD] reduction
- 13.3% [8.8%]
- Other surgical categories, neuraxial, mean [SD] reduction
- 17.6% [9.9%]
Original publication
Variation in Intraoperative Opioid Administration by Patient, Clinician, and Hospital Contribution. JAMA Netw Open. Published 2 January 2024. doi:10.
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