This informational measure (there is no threshold or target) is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.
Cases are grouped by surgical site using CPT groupings (see below). 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).
Anesthesia Start to Anesthesia End
All patients undergoing a procedure within the following primary anesthesia CPT groupings:
Cardiac
Spine (Adult): Patients ≥ 18yo
Spine (Pediatric): Patients < 18yo
Upper Abdomen
Lower Abdomen
Hysterectomy
Knee/Popliteal
Hip
Tonsil/Adenoid (Pediatrics)
Any procedure not listed in one of the inclusion categories above
Success is not defined for these measures- informational only
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 |
120.00 |
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 |
0.40 |
Nalbuphine1 |
IV |
10.00 |
Butorphanol1 |
IV |
2.00 |
Alfentanil7 |
IV |
0.50 |
Sufentanil5 |
IV |
0.01 |
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.
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)
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.
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
Provider signed in for largest portion of case using Case Duration.
Algorithm for determining Case Duration:
Case Start:
1. Anesthesia Induction End. If not available, then
2. Anesthesia Induction Begin. If not available, then
3. Procedure Start. If not available, then
4. Patient in Room. If not available, then
5. Anesthesia Start
Case End:
1. Patient Extubated. If not available, then
2. Procedure End. If not available, then
3. Patient Out of Room. If not available, then
4. Anesthesia End.
MPOG Medication Concept IDs |
|
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 |
MPOG Route Concept IDs |
|
2001 |
IV |
2004 |
INTRATHECAL |
2005 |
EPIDURAL |
2008 |
ORAL |
2013 |
TOPICAL |
2014 |
TRANSDERMAL |
2026 |
CAUDAL |
2998 |
OTHER - NOT SPECIFIED |
MPOG Unit of Measure Concept IDs |
|
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 |
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.
Not applicable
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