Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

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48 Results of the adult economic evaluation TABLE 20 Patient characteristics by anaesthetic regimen in the adult study * Parameter Anaesthetic regimen Total and 19 non-consultant anaesthetists carried out 268 procedures. The 1063 patients were treated by 34 surgeons of consultant and nonconsultant grades. Of the 1063 adult study participants, 156 (14.7%) were single, 751 (70.6%) were married, 116 (10.9%) were separated, 38 (3.6%) were widowed and two did not answer. Three-hundred and sixtytwo (34.1%) adult study participants were current smokers and 271 (25.5%) were ex-smokers. Employment details were recorded and categorised into social class for all male participants and for the male partners of female participants (employed and retired). In the case of single women, their own social class was recorded (see Table 21). Propofol/ Propofol/ Propofol/ Sevoflurane/ propofol isoflurane sevoflurane sevoflurane No. of patients 265 267 280 251 1063 Mean age 44.7 44.3 43.5 43.8 44.1 (median, SD, range) (41.0, 15.3, (42.1, 15.4, (41.3, 15.0, (40.4, 14.9, (41.3, 15.1, (years) 18.1–80.8) 17.6–86.6) 17.7–83.6) 19.0–87.5) 17.6–87.5) ASA grade I 182 182 187 169 720 (67.7%) ASA grade II 76 78 83 72 309 (29.1%) ASA grade III 2 0 6 3 11 (1.0%) ASA grade not known 5 7 4 7 23 (2.2%) Type of surgery Gynaecology, minor 72 81 81 71 305 (28.7%) Gynaecology, intermediate 66 62 71 66 265 (24.9%) Urology 44 45 45 38 172 (16.2%) Knee 21 24 18 16 79 (7.4%) Peritoneum 14 10 12 18 54 (5.1%) Penis 15 8 13 10 46 (4.3%) Vulva/vagina 7 13 6 6 32 (3.0%) Tendons, muscles 5 7 6 7 25 (2.4%) Peripheral, leg 5 3 8 5 21 (2.0%) Skin, minor 3 5 6 2 16 (1.5%) Bone 6 1 4 2 13 (1.2%) Gastrointestinal, intermediate 4 2 2 2 10 (0.9%) Joint 0 1 4 3 8 (0.8%) Cervix 2 2 0 3 7 (0.7%) Scrotum/testes 1 2 3 0 6 (0.6%) Gastrointestinal, minor; breast; ear, minor 0 1 1 2 4 (0.4%) * See appendix 25 261 for surgical procedure categorisation and summary groups TABLE 21 The social class of the participants in the adult study Social class No. of British value patients (%) 246 I 50 (4%) 5 II 144 (13%) 16 IIIN 139 (13%) 35 IIIM 130 (12%) 19 IV 105 (9%) 18 V 16 (1%) 6 Unemployed, student, 479 (45%) Not given housewife
Clinical outcome data PONV by anaesthetic regimen The incidence of PONV was analysed to assess whether the risk of PONV differed between the anaesthetic regimens. First, the crude (unadjusted) figures were tabulated. Further tables in appendix 26 display the association between PONV and other variables that plausibly might be associated with risk. Logistic regression analysis was employed to confirm the impression portrayed by the tabular analyses. It also adjusted the estimates of PONV risk to allow for any residual effects of the potential confounding variables that might arise from them not being exactly evenly distributed across the randomisation arms. The total numbers of subjects shown in the tables vary slightly, since some of the variables have missing data. Probability values presented with tables refer, unless otherwise stated, to a simple test for heterogeneity among categories. So-called ‘exact’ tests were employed when appropriate. Probability values are not TABLE 22 The occurrence of any PONV by anaesthetic regimen in the adult study © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 presented for tables examining the distribution of potential confounding variables among the randomisation categories, as the statistical significance of observed differences is not relevant to the question of confounding. Tables 22 and 23 give the occurrence of PONV, at varying degrees of severity, within the randomisation categories. For all PONV and for one or more episodes of vomiting a substantially larger proportion of cases occurred with the sevoflurane/ sevoflurane regimen than with the others: 30% of the sevoflurane/sevoflurane category suffered PONV compared to 20% overall. Propofol/ propofol appears to have the lowest (crude) incidence of PONV. Using this as the reference category the odds ratio (OR) for PONV in the sevoflurane/sevoflurane category is 2.7, suggesting a nearly three-fold risk of PONV. When one or more episodes of vomiting is considered the OR appears to be 6.14. However, this estimate is based on a small number of events, and is unreliable. TABLE 23 The occurrence of one or more episodes of vomiting by anaesthetic regimen in the adult study Anaesthetic regimen Total Propofol/ Propofol/ Propofol/ Sevoflurane/ propofol isoflurane sevoflurane sevoflurane Total No. of patients 265 (100%) 267 (100%) 280 (100%) 251 (100%) 1063 (100%) One or more episodes of vomiting – no 260 (98.1%) 253 (94.8%) 270 (96.4%) 225 (89.6%) 1008 (94.8%) One or more episodes of vomiting – yes 5 (1.9%) 14 (5.2%) 10 (3.6%) 26 (10.4%) 55 (5.2%) OR * 1.00 2.88 1.96 6.14 – (0.96–10.34) (0.60–7.41) (2.26–20.75) * Calculated using propofol/propofol as reference Anaesthetic regimen Total Propofol/ Propofol/ Propofol/ Sevoflurane/ propofol isoflurane sevoflurane sevoflurane Total No. of patients 265 (100%) 267 (100%) 280 (100%) 251 (100%) 1063 (100%) Nausea or vomiting – no 228 (86.0%) * 218 (81.6%) † 234 (83.6%) ‡ 176 (70.1%) *†‡ 856 (80.5%) Nausea or vomiting – yes 37 (14.0%) 49 (18.4%) 46 (16.4%) 75 (29.9%) 207 (19.5%) OR § * Versus sevoflurane/sevoflurane,p = 0.001; versus other arms, not significant † Versus sevoflurane/sevoflurane,p = 0.003; versus other arms, not significant ‡ Versus sevoflurane/sevoflurane,p = 0.001; versus other arms, not significant § Calculated using propofol/propofol as reference 1.00 1.38 (0.85–2.27) 1.24 (0.75–2.04) 2.69 (1.70–4.31) – 49
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Which anaesthetic agents are costef
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Which anaesthetic agents are costef
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NHS R&D HTA Programme The NHS R&D H
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Contents Appendix 6 Adult patient-b
Page 11 and 12: Background The aim of the project w
Page 13: • The incidence of PONV was low d
Page 16 and 17: 2 Introduction dizziness or disorie
Page 18 and 19: 4 Introduction a reduced incidence
Page 20 and 21: 6 Introduction willingness to pay f
Page 22 and 23: 8 Literature review included in the
Page 24 and 25: 10 Literature review TABLE 1 Compar
Page 26 and 27: 12 Literature review intermediate a
Page 32 and 33: 18 Literature review Patient-based
Page 34 and 35: 20 Literature review TABLE 5 contd
Page 36 and 37: 22 Literature review No studies fol
Page 38 and 39: 24 Literature review (30%) and meth
Page 40 and 41: 26 Literature review • There are
Page 42 and 43: 28 National survey of anaesthetic p
Page 50 and 51: 36 Economic evaluation methods (inc
Page 52 and 53: 38 Economic evaluation methods The
Page 54 and 55: 40 Economic evaluation methods Tabl
Page 56 and 57: 42 Economic evaluation methods simi
Page 58 and 59: 44 Economic evaluation methods Prob
Page 61: Recruitment to the CESA RCT The stu
Page 65 and 66: The findings from the logistic regr
Page 67 and 68: TABLE 29 The length of stay and pri
Page 69 and 70: 140 120 100 80 60 40 20 0 No. of pa
Page 71 and 72: 250 200 150 100 50 0 No. of patient
Page 73 and 74: TABLE 37 Deterministic sensitivity
Page 75 and 76: 20 15 10 5 0 -5 Difference in varia
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Page 81 and 82: Recruitment to the CESA RCT The stu
Page 83 and 84: TABLE 49 The occurrence of any PONV
Page 85 and 86: 60 50 40 30 20 10 0 No. of patients
Page 87 and 88: a scale effect for scenario A, but
Page 89 and 90: The mean CVs for avoidance of PONV
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Page 95 and 96: The structure and content of this d
Page 97 and 98: nurses to have an in-depth knowledg
Page 99 and 100: agent used (see appendix 18). It wa
Page 101 and 102: Furthermore, anaesthetists operate
Page 103 and 104: The CESA project was designed to as
Page 105: practice, such as the use of midazo
Page 109 and 110: 1. Royal College of Surgeons of Eng
Page 111 and 112: 60. Cheng KI, Chu KS, Fang YR, Su K
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112. Raeder J, Gupta A, Pedersen FM
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162. Viitanen H, Baer G, Annila P.
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220. Rosenberg KM, Bridge P, Brown
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The range of databases interrogated
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24. preferen$.mp. [mp=title, abstra
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110 Appendix 2 TABLE 65 contd Summa
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112 Appendix 3 Quality assessment o
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TABLE 69 Summary of paediatric pati
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TABLE 69 contd Summary of paediatri
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TABLE 70 Characteristics of cost or
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TABLE 71 Quality of cost or economi
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TABLE 71 contd Quality of cost or e
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Abbott J, Abbott P. Psychological a
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Hall JE, Stewart JIM, Harmer M. Sin
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Struys M, Versichelen L, Thas O, He
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182 Appendix 11
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184 Appendix 11
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186 Appendix 11
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188 Appendix 11
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The aim of this study was to develo
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anaesthetics in day surgery, using
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© Queen’s Printer and Controller
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Background The empirical study quan
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Satisfaction with care Nearly all (
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TABLE 76 Reason given for preferenc
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TABLE 79 Comparisons with previous
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TABLE 80 Reason given for preferenc
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TABLE 81 Reason given for willingne
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Background Variable costs account f
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TABLE 85 Unit costs for the purchas
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Background The empirical study requ
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Ethical approval This was covered b
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20 15 10 5 0 -5 -10 -15 True weight
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15 10 5 0 -5 -10 True weight - Dion
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224 Appendix 19 • patients aged o
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All staff unit costs were for the y
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Background Fixed costs account for
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232 Appendix 22 March, Tuesday 15 A
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234 Appendix 23 TABLE 96 Reasons fo
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Patients were coded using the OPCS
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Q03.4 punch biopsy of cervix Q03.5
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This section displays the associati
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given in Table 103 confirm the age
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TABLE 107 Occurrence of PONV by dur
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248 Appendix 27 TABLE 113 Frequency
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This section displays the associati
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The adverse events observed in the
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262 Health Technology Assessment Pr
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264 Health Technology Assessment Pr
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