Measure ID
Opioid Equivalency
Domain
Description

Cases are grouped by surgical site using CPT groupings (see Inclusion Criteria).  Opioid equivalents are calculated using conversions derived from literature and given between anesthesia start and anesthesia end for each case.  This value is normalized to patient weight (kg) and duration of anesthetic (anesthesia end – anesthesia start, hours as a decimal).

Measure Type
Process
Available for Provider Feedback
No - Departmental Only
Threshold
Not applicable - Informational only
Rationale

Understanding opioid administration is important to help improve perioperative care.  There has been a dedicated focus on understanding opioid use within and outside the hospital and an equivalency is often used to compare opioid consumption.  As Oral Morphine Equivalent (OME) conversions are limited to medications routinely used outside of the operating room (OR) and omit some critical medications and routes used in the OR, a new algorithm was developed to incorporate medications used intraoperatively.  This equivalency is intended as an informational tool to help understand opioid use in the operating room. 

Measure Time Period
Inclusions

All patients undergoing a procedure within the following primary anesthesia CPT groupings:

Cardiac

  • Cardiac surgery with pump and > 1 year old (CPT: 00562)
  • Cardiac surgery with hypothermic arrest (CPT: 00563)
  • CABG with pump (CPT: 00567)
  • Heart Transplant (CPT: 00580)
  • CABG without pump (CPT:00566)

Spine (Adult)Age ≥ 18 years 

  • Cervical spine and cord; not otherwise specified (CPT: 00600)
  • Cervical spine and cord; patient in sitting position (CPT: 00604)
  • Thoracic spine and cord; not otherwise specified (CPT: 00620)
  • Thoracic spine and cord; thoracolumbar sympathectomy (CPT: 00622)
  • Thoracic spine and cord, via an anterior transthoracic approach; not utilizing 1 lung ventilation (CPT: 00625)
  • Thoracic spine and cord, via an anterior transthoracic approach; utilizing 1 lung ventilation (CPT: 00626)
  • Lumbar region; not otherwise specified (CPT: 00630)
  • Lumbar region; lumbar sympathectomy (CPT: 00632)
  • Lumbar region; diagnostic or therapeutic lumbar puncture (CPT: 00635)
  • Extensive spine and spinal cord procedures (eg, spinal instrumentation or vascular procedures) (CPT: 00670)

Spine (Pediatric)Age <18 years 

  • Cervical spine and cord; not otherwise specified (CPT: 00600)
  • Cervical spine and cord; patient in sitting position (CPT: 00604)
  • Thoracic spine and cord; not otherwise specified (CPT: 00620)
  • Thoracic spine and cord, via an anterior transthoracic approach; not utilizing 1 lung ventilation (CPT: 00625)
  • Thoracic spine and cord, via an anterior transthoracic approach; utilizing 1 lung ventilation (CPT: 00626)
  • Lumbar region; not otherwise specified (CPT: 00630)
  • Extensive spine and spinal cord procedures (eg, spinal instrumentation or vascular procedures) (CPT: 00670)

Upper Abdomen

  • Intraperitoneal - upper abdomen including laparoscopy; not otherwise specified (CPT: 00790)
  • partial hepatectomy or management of liver hemorrhage (excluding liver biopsy) (CPT: 00792)
  • Intraperitoneal - upper abdomen including laparoscopy; pancreatectomy, partial or total (eg, Whipple) (CPT: 00794)
  • Intraperitoneal - upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity (CPT: 00797)

Lower Abdomen

  • Procedures in lower abdomen including laparoscopy; not otherwise specified (CPT: 00840)
  • Procedures in lower abdomen including laparoscopy; abdominoperineal resection (CPT: 00844)
  • Procedures in lower abdomen including laparoscopy; pelvic exenteration (CPT: 00848)

Hysterectomy

  • Intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy (00846)
  • Vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal hysterectomy (00944)

Knee/Popliteal

  • Open or surgical arthroscopic procedures on knee joint; total knee arthroplasty (01402)

Hip

  • Open procedures involving hip joint; total hip arthroplasty (01214)

Tonsil/Adenoid (Pediatrics)Age <18 years 

Exclusions

Any procedure not listed in one of the inclusion categories above

Success Criteria

Success is not defined for these measures.

Other Measure Details

Other Measure Build Details:

Medication combinations are calculated using the medication concept IDs, route of delivery, and unit of measure as listed above.  Not all possible combinations are used as some routes or units are not used for certain medications in medical practice.  Remifentanil is not included in the opioid equivalency calculation due to its short duration of action and low context-sensitive half-time. Opioid equivalency is still calculated for these cases that use remifentanil but the cases are flagged as having “Remi”.  When an opioid dose cannot be calculated for a medication due to inadequate documentation, the opioid equivalency is returned for the remaining medications and the case is also flagged as having an opioid given with an “Unknown” dose.

If weight and/or anesthesia duration is missing for the case, the opioid equivalency is returned as NULL.

The following conversions were used for opioid equivalency conversions:

Opioid

Route

Multiplier

 Morphine1,2

 Oral

 30.00

 MS Contin (controlled release)

 Oral

 30.00

 Codeine1,2

 Oral

 200.00

 Hydromorphone (Dilaudid) 1,2

 Oral

 7.50

 Hydrocodone2

 Oral

 30.00

 Oxycodone1,2

 Oral

 20.00

 Oxymorphone1,2

 Oral

 10.00

 Meperidine1

 Oral

 300.00

 Levorphanol1

 Oral

 2.00

 Tramadol1

 Oral

 300.00

 Tapentadol1

 Oral

 100.00

 Methadone8

 Oral

 6.00

 Fentanyl2

 Transdermal

 12.50

 Buprenorphine (Suboxone) 3

 Sublingual

 0.40

 Morphine1

 IV

 10.00

 Codeine1

 IV

 100.00

 Fentanyl1

 IV

 0.10

 Hydromorphone (Dilaudid) 1

 IV

 1.50

 Oxymorphone1

 IV

 1.00

 Meperidine1

 IV

 100.00

 Tramadol1

 IV

 100.00

 Buprenorphine (Suboxone) 1

 IV

 75.00

 Nalbuphine1

 IV

 10.00

 Butorphanol1

 IV

 2.00

 Alfentanil7

 IV

 0.50

 Sufentanil5

 IV

 0.02

 Remifentanil

 IV

 0.00

 Methadone3

 IV

 5.00

 Hydromorphone6

 Epidural

 0.30

 Morphine4

 Epidural

 1.00

 Fentanyl6

 Epidural

 0.03

 Fentanyl6

 IT

 0.01

 Morphine4

 IT

 0.10

 Hydromorphone6

 IT

 0.06

Example: A 10 kg patient receives 100mcg of fentanyl for induction (100 ug total for the case) for a 4.0 hour case.

  1. First we calculate the /kg/hr IV OME for the case: 0.1mg fentanyl / 10 kg / 4.0 hour = 0.1/10/4 = 0.0025 OME mg/(kg*hr)
  2. Next, we multiply by 3 to calculate PO OME: 0.0025 * 3 = 0.0075 mg/(kg*hr) PO OME
    • Each case grouping (Spine, Cardiac etc) a "standard" weight and case length has been assigned to help allow for case-to-case comparisons. Let’s pretend the standard chosen for this example is 20 kg patient and 3 hour case.
  3. Then, we would report the following for this case: 0.0075 mg/(kg*hr) * 20kg * 3 hours = 0.45 PO OME 
    • The PO OME value is then used to convert and display the Fentanyl IV, Morphine IV and Morphine PO equivalent.
      • (ome.Value * 10.0 / 3.0)  -- Fentanyl IV
      • (ome.Value / 3.0)   --- Morphine IV
      • (ome.Value)   --- Morphine PO

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Risk Adjustment

Not applicable

Provider Attribution

Provider(s) signed in for largest duration between anesthesia start and anesthesia end

 

MPOG Concept Used

Medication

  • 10008  BUPIVACAINE W/ HYDROMORPHONE 0.1% / UNSPECIFIED
  • 10020  ALFENTANIL
  • 10077  BUPIVACAINE W/ FENTANYL 0.0625% / 3mcg/ml
  • 10079  BUPIVACAINE W/ FENTANYL 0.08% / 2 MCG/ML
  • 10080  BUPIVACAINE W/ FENTANYL 0.125% / 2 MCG/ML
  • 10081  BUPIVACAINE W/ FENTANYL 0.125% / 3 MCG/ML
  • 10082  BUPIVACAINE W/ HYDROMORPHONE 0.0625% / 5mcg/ml
  • 10083  BUPIVACAINE W/ HYDROMORPHONE 0.0625% /10 mcg/ml
  • 10089  BUTORPHANOL
  • 10103  BUPIVACAINE W/ FENTANYL 0.125% / 5 MCG/ML
  • 10186  FENTANYL
  • 10219  HYDROMORPHONE
  • 10279  MEPERIDINE
  • 10290  METHADONE
  • 10306  MORPHINE
  • 10311  NALBUPHINE
  • 10341  OXYCODONE
  • 10378  PROPOFOL W/ REMIFENTANIL 10 MG/ML + 5 MCG/ML
  • 10390  REMIFENTANIL
  • 10408  BUPIVACAINE W/ FENTANYL 0.0625% / 5 MCG/ML
  • 10414  SUFENTANIL
  • 10439  BUPIVACAINE W/ SUFENTANIL W/ EPINEPHRINE 100MG / 100MCG / 0.42MG
  • 10475  BUPIVACAINE W/ HYDROMORPHONE 0.125% / 5 MCG/ML
  • 10476  BUPIVACAINE W/ HYDROMORPHONE 0.125% / 10 MCG/ML
  • 10478  LIDOCAINE W/ HYDROMORPHONE 2% / 10 MCG / ML
  • 10479  LIDOCAINE W/ FENTANYL W/ EPINEPHRINE W/ BICARBONATE 2% / 5 MCG/ML / 1:200,000
  • 10481  OXYCODONE / ACETAMINOPHEN 5 MG / 325 MG
  • 10482  HYDROCODONE / ACETAMINOPHEN 5 MG / 325 MG
  • 10483  HYDROCODONE / ACETAMINOPHEN 7.5 MG / 500 MG
  • 10484  CODEINE / ACETAMINOPHEN 12 MG / 120 MG
  • 10485  CODEINE / ACETAMINOPHEN 30 MG / 300 MG
  • 10486  BUPIVACAINE W/ FENTANYL 0.5% / 3 MCG/ML
  • 10488  BUPIVACAINE W/ FENTANYL 0.5% / 10 MCG/ML
  • 10518  BUPIVACAINE W/ HYDROMORPHONE 0.5% / 10 MCG/ML
  • 10519  BUPIVACAINE W/ FENTANYL 0.05% / 3 MCG/ML
  • 10522  BUPIVACAINE W/ MORPHINE 0.75% W/0.2 MG
  • 10534  BUPIVACAINE W/ FENTANYL 0.0625% / 2 MCG/ML
  • 10536  BUPIVACAINE W/ FENTANYL 0.0625%/ 10 MCG/ML
  • 10554  BUPIVACAINE W/ FENTANYL 0.1% / 2 MCG/ML
  • 10583  BUPIVACAINE W/ FENTANYL 0.0625%/ 4 MCG/ML
  • 10585  BUPIVACAINE W/ FENTANYL 0.125% / 4 MCG/ML
  • 10587  CODEINE
  • 10597  PROPOFOL W/ ALFENTANIL 10 MG/ML + 50 MCG/ML
  • 10603  BUPIVACAINE W/ HYDROMORPHONE 0.05% /10 mcg/ml
  • 10620  BUPIVICAINE W/ FENTANYL 0.125% / 10MCG/ML
  • 10633  ROPIVACAINE W/ FENTANYL  0.125% / 2 MCG/ML
  • 10639  PROPOFOL W/ REMIFENTANIL 10 MG/ML + 10 MCG/ML
  • 10649  PROPOFOL W/ REMIFENTANIL 10 MG/ML + 20 MCG/ML
  • 10669  BUPIVACAINE W/ FENTANYL 0.25% / 10 MCG/ML
  • 11020  TRAMADOL
  • 11080  BUPRENORPHINE
  • 11120  BUPIVACAINE W/ FENTANYL 0.05% / 5 MCG/ML
  • 11130  BUPIVACAINE W/ FENTANYL 0.25% / 2.5 MCG/ML
  • 11140  BUPIVACAINE W/ FENTANYL 0.05% / 2 MCG/ML

Routes

  • 2001  IV
  • 2004  INTRATHECAL
  • 2005  EPIDURAL
  • 2008  ORAL
  • 2013  TOPICAL
  • 2014  TRANSDERMAL
  • 2026  CAUDAL
  • 2998  OTHER - NOT SPECIFIED

Units

  • 1005  MG
  • 1007  MG/ML
  • 1010  MCG
  • 1011  MCG/KG
  • 1012  MCG/ML
  • 1015  GM
  • 1020  UNITS
  • 1025  ML
  • 1030  MILLIEQUIVALENTS
  • 1037  NANOGRAM
  • 1100  ML/HR
  • 1103  MEQ/HR
  • 1105  MG/HR
  • 1110  UNITS/HR
  • 1115  GM/HR
  • 1120  MCG/HR
  • 1135  ML/MIN
  • 1140  MG/MIN
  • 1150  MCG/MIN
  • 1200  MG/KG/HR
  • 1205  MCG/KG/HR
  • 1210  UNITS/KG/HR
  • 1220  MG/KG/MIN
  • 1225  MCG/KG/MIN
  • 1999  OTHER
MPOG Phenotypes Used
References
  1. APS. Principles of Analgesic Use, 7th Edition. In: Christopher M. Herndon PA, Beth Darnall, Craig Hartrick, Keith Hecht, Mary Lyons, Jahangir Maleki, Renee Manworren, Christine Miaskowski, Nalini Sehgal, editor. Principles of Analgesic Use. 7th ed2016. p. Table 2.
  2. Dowell D HT, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016. 2016;65(No. RR-1):1–49.
  3. McPherson ML. Demystifying Opioid Conversion Calculations: A Guide to Effective Dosing. Bethesda, MD: American Society of Health-System Pharmacists; 2009. 208 p.
  4. Krames ES. Intrathecal infusional therapies for intractable pain: Patient management guidelines. Journal of Pain and Symptom Management.8(1):36-46.
  5. Anderson R, Saiers JH, Abram S, Schlicht C. Accuracy in Equianalgesic Dosing. Journal of Pain and Symptom Management.21(5):397-406.
  6. OpenAnesthesia , https://www.openanesthesia.org/
  7. Koyyalagunta, D.  Pain Management, 2007, Chapter 113: Opioid Analgesics.  Pain Management, 113(2), 2007, Pages 939-964
  8. Walker, PW, et. al. Switching from Methadone to a Different Opioid: What Is the Equianalgesic Dose Ratio?  Journal of Palliative Medicine.11(8), 2008, Pages 1103-1108
Measure Authors

 Measure Authors

 Institution

 Mike Burns, MD

 University of Michigan

 John Vandervest, MS

 University of Michigan

 Kate Buehler, MS, RN

 University of Michigan

 Baorong Shi

 University of Michigan

 Nirav Shah, MD

 University of Michigan

 MPOG Quality Committee

 

 

Measure Reviewer(s)
Next Review: 2026
 Date Reviewed  Reviewer  Institution  Summary  QC Vote

01/23/2023

Mike Burns, MD University of Michigan Review Modify
Version
Published Date: 07/2018
 Date  Criteria  Revision
Pending   Result separate OME values for Intraop, PACU and Periop
07/2018 Initial Publication