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50 Results of the adult economic evaluation The question of whether the relatively small differences in the risk of experiencing the other categories of PONV are compatible with chance effects was deferred until the logistic regression analysis. Two or more episodes of vomiting (Table 24) were so unusual that there are insufficient events for meaningful tabular analysis. Table 25 displays the occurrence of PONV by randomisation group within each of the predefined study strata for randomisation. The small sizes of some of the strata lead to there being considerable random fog in the estimates of the risk of PONV. Nevertheless, the risk of PONV is markedly greatest in most of the strata under the sevoflurane/sevoflurane regimen. Other adverse events Table 26 summarises the degree-of-orientation categories of patients in recovery. Such differences as occur are small. Other adverse events were recorded in the anaesthetic room, operating theatre, recovery room and ward. There was a low incidence of adverse events overall, and these are summarised in appendix 27. There was no difference between randomisation arms. Previous anaesthetic experience Patients reported a mean of 3.2 previous anaesthetic experiences (median 2.0, SD 3.8, range 0–41). There was no difference between randomised groups. Logistic regression analysis of PONV Logistic regression was employed using as the binary dependent variable either the presence/ absence of any nausea or vomiting or the presence/absence of one or more episodes of vomiting. These analyses are not wholly independent of one another, but they serve to elucidate some of the fine detail of the patterns in the data and to adjust the estimates of the risks of PONV among the various anaesthetic regimens. The independent variables explored were anaesthetic regimen (categorical), age (numeric), gender (categorical), orientation (categorical), duration of anaesthesia (numeric), ASA grade (categorical), previous anaesthetics (numeric) and surgical procedure (categorical). The analysis was performed in an exploratory manner (informed by the findings from the tables) rather than merely letting the analytic routine find the best-fitting, and not necessarily most informative, model. The final model selected (see below) turned out to be the best fitting, most parsimonious and intuitively most appealing among several candidate models. The ASA grade and number of previous anaesthetics contributed nothing to the fit of the models and were discarded. The surgical procedure variable consisted of five groups (orthopaedic, male and female; general surgical, male and female; gynaecology) and thus contained information on gender and could not usefully be included in the regression model at the same time as gender. However, this variable was explored as an alternative to gender, but eventually discarded. A variant of the procedure categories pooled for the genders could be included in the model at the same time as gender, but contributed no explanatory power. It should be borne in mind that, as approximately half of the surgical procedures were for women only (gynaecology), and that as two-thirds of the adult patients were women, it is not surprising that this set of data offers only limited opportunities to explore the influence of gender and surgical procedure. No interaction terms, either between the anaesthetic regimen categories and the other variables, or between the other variables themselves, contributed anything useful to either the fit or the interpretation of the model. TABLE 24 The occurrence of two 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%) Two or more episodes of vomiting – no 264 (99.6%) 260 (97.4%) 274 (97.8%) 244 (97.2%) 1042 (98.0%) Two or more episodes of vomiting – yes 1 (0.4%) 7 (2.6%) 6 (2.2%) 7 (2.8%) 21 (2.0%) χ 2 :p > 0.1
The findings from the logistic regression analyses are summarised in Tables 27 and 28. The ORs for age and duration of anaesthesia are displayed in two different ways to assist understanding. The adjusted ORs for the anaesthesia regimens are close to those shown in Tables 23 and 24. The risk of PONV or vomiting occurring is greatest for sevoflurane/sevoflurane, and this finding is © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 TABLE 25 The occurrence of PONV by the strata within which random allocation to anaesthetic regimens was made in the adult study Anaesthetic regimen Total Stratum Nausea or Propofol/ Propofol/ Propofol/ Sevoflurane/ vomiting propofol isoflurane sevoflurane sevoflurane General, None 18 (85.7%) 14 (82.4%) 19 (86.4%) 14 (82.4%) 65 (84.4%) female (Wirral) Some 3 (14.3%) 3 (17.6%) 3 (13.6%) 3 (17.6%) 12 (15.6%) Total 21 (100.0%) 17 (100.0%) 22 (100.0%) 17 (100.0%) 77 (100.0%) OR * 1 1.29 0.95 1.29 – General, None 45 (100.0%) 47 (100.0%) 48 (95.9%) 38 (90.5%) 177 (96.7%) male (Wirral) Some 0 (0%) 0 (0%) 2 (4.1%) 4 (9.5%) 6 (3.3%) Total 45 (100.0%) 47 (100.0%) 50 (100.0%) 42 (100.0%) 184 (100.0%) OR † – – 1 2.53 – Gynaecology None 119 (82.6%) 109 (74.1%) 121 (79.6%) 88 (63.8%) 437 (75.2%) (Wirral) Some 25 (17.4%) 38 (25.9%) 31 (20.4%) 50 (36.2%) 144 (24.8%) Total 144 (100.0%) 147 (100.0%) 152 (100.0%) 138 (100.0%) 581 (100.0%) OR * 1 1.66 1.22 2.71 – Gynaecology None 21 (75.0%) 19 (76.0%) 16 (64.0%) 13 (52.0%) 69 (67.0%) (St. Marys) Some 7 (25.0%) 6 (24.0%) 9 (36.0%) 12 (48.0%) 34 (33.0%) Total 28 (100.0%) 25 (100.0%) 25 (100.0%) 25 (100.0%) 103 (100.0%) OR * 1 0.95 1.69 2.77 – Orthopaedics, None 7 (87.5%) 6 (75.0%) 7 (87.5%) 4 (57.1%) 24 (77.4%) female (Wirral) Some 1 (12.5%) 2 (25.0%) 1 (12.5%) 3 (42.9%) 7 (22.6%) Total 8 (100.0%) 8 (100.0%) 8 (100.0%) 7 (100.0%) 31 (100.0%) OR * 1 2.33 1.00 5.25 – Orthopaedics, None 20 (95.2%) 25 (100.0%) 20 (100.0%) 16 (84.2%) 81 (95.3%) male (Wirral) Some 1 (4.8%) 0 (0%) 0 (0%) 3 (15.8%) 4 (4.7%) Total 21 (100.0%) 25 (100.0%) 20 (100.0%) 19 (100.0%) 85 (100.0%) OR * 1 – – 3.75 – * Reference regimen propofol/propofol; † Reference regimen propofol/sevoflurane TABLE 26 The degree of orientation during recovery from anaesthesia in the adult study * Degree of orientation Anaesthetic regimen Total Propofol/ Propofol/ Propofol/ Sevoflurane/ propofol isoflurane sevoflurane sevoflurane Total 264 (100%) 267 (100%) 277 (100%) 246 (100%) 1054 (100%) Alert 158 (59.8%) 158 (59.3%) 163 (58.8%) 140 (56.9%) 619 (58.8%) Agitated and distressed 15 (5.7%) 21 (7.8%) 13 (4.7%) 19 (7.7%) 68 (6.4%) Drowsy 91 (34.5%) 88 (32.8%) 101 (36.5%) 87 (35.4%) 367 (34.8%) * Nine missing values extremely unlikely to be due to chance. Examination of the 95% CIs indicates that any differences between the other three regimens are compatible with chance effects. The findings for age, gender, orientation in recovery and duration of anaesthesia are consistent with those from the tabular analyses. None of these findings is surprising, given that the tabular analyses had 51
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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
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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
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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
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Page 42 and 43: 28 National survey of anaesthetic p
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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 and 62: Recruitment to the CESA RCT The stu
Page 63: Clinical outcome data PONV by anaes
Page 67 and 68: TABLE 29 The length of stay and pri
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Page 73 and 74: TABLE 37 Deterministic sensitivity
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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
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Page 89 and 90: The mean CVs for avoidance of PONV
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Page 99 and 100: agent used (see appendix 18). It wa
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Page 103 and 104: The CESA project was designed to as
Page 105: practice, such as the use of midazo
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Page 111 and 112: 60. Cheng KI, Chu KS, Fang YR, Su K
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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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