Measure Abbreviation
Opioid Equivalency
Data Collection Method

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.

Measure Type
Process
Description

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).

Measure Time Period

Anesthesia Start to Anesthesia End

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

  • 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)

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)

  • Anesthesia for intraoral procedures, including biopsy; not otherwise specified (CPT: 00170)
  • Procedure text includes "tonsil" or "adeniod"
Exclusions

Any procedure not listed in one of the inclusion categories above

Success

Success is not defined for these measures- informational only

Other Measure Build 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

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

Responsible Provider

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.   

Threshold
None
MPOG Concept IDs Required

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

Data Diagnostics Affected
  • Percentage of medications with a Meaningful Medication Mapping
  • Percentage of medications with a Meaningful Route Mapping
  • Percentage of medications with a Meaningful Unit Mapping
  • Percentage of cases with Bolus Medications
  • Percentage of Cases with Infusion Medications
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. 

Risk Adjustment

Not applicable

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