Variations in the Use of Perioperative Multimodal Analgesic Therapy

Abstract

Objective

Practice guidelines for perioperative pain management recommend that multimodal analgesic therapy should be used for all post-surgical patients. However, the proportion of patients whom actually receive this evidence-based approach is currently 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 non-opioid 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 one 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%. In a secondary analysis, we examined whether patients received two or more non-opioid 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%.

Conclusion

In this large nationwide sample of surgical admissions in the United States we observed tremendous variation in the utilization of multimodal therapy use 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.