caa a22 4500 445373210 CHVBK 20180317142954.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s00540-011-1221-5 doi (NATIONALLICENCE)springer-10.1007/s00540-011-1221-5 Impact of remifentanil introduction on practice patterns in general anesthesia [Elektronische Daten] [Kanji Uchida, Hideo Yasunaga, Hiroaki Miyata, Masahiko Sumitani, Hiromasa Horiguchi, Ken Kuwajima, Shinya Matsuda, Yoshitsugu Yamada] Purpose: The introduction of new medicine can change clinical practice patterns and may affect patient outcomes. In the present study, we investigated whether introduction of remifentanil in Japan affected the practice patterns of anesthesia. Methods: Using the Japanese Diagnosis Procedure Combination database, we extracted records of 423,491 patients who underwent surgery with general anesthesia in 243 hospitals before (2006) and after (2007) the introduction of remifentanil, and identified anesthetic agents used for each patient. A hierarchical mixed-effects logistic regression analysis was performed to analyze the factors that affected selection of remifentanil. Further, we compared postoperative length of stay (LOS), in-hospital mortality, and total costs between 2006 and 2007. Results: In 2007, remifentanil was used for up to 41.4% of all general anesthesia, accompanied by a reduction in nitrous oxide use and an increase in total intravenous anesthesia. Female gender, increasing age, and preoperative comorbidities including diabetes mellitus, hypertension, liver cirrhosis, and chronic renal failure were positively associated with the use of remifentanil, whereas accompanying cardiac disease and co-application of epidural anesthesia were negatively associated. In 2007, a similar in-hospital death rate, similar or decreased total costs, slightly reduced duration of anesthesia, and substantially reduced postoperative LOS were seen compared to those in 2006. Conclusions: Our data revealed rapid changes in practice patterns in anesthesia after the introduction of remifentanil in Japan. Remifentanil was used more often in patients with comorbidities and without epidural anesthesia, and its introduction did not affect increase in total medical costs. Japanese Society of Anesthesiologists, 2011 Remifentanil nationallicence Anesthetic practice nationallicence Postoperative outcome nationallicence In-patient medical cost nationallicence Uchida Kanji Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Yasunaga Hideo Department of Health Management and Policy, Tokyo University Graduate School of Medicine, Tokyo, Japan aut Miyata Hiroaki Department of Health Quality Assessment, Tokyo University Graduate School of Medicine, Tokyo, Japan aut Sumitani Masahiko Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Horiguchi Hiromasa Department of Health Management and Policy, Tokyo University Graduate School of Medicine, Tokyo, Japan aut Kuwajima Ken Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Matsuda Shinya Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan aut Yamada Yoshitsugu Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Journal of Anesthesia Springer Japan 25/6(2011-12-01), 864-871 0913-8668 25:6<864 2011 25 540 https://doi.org/10.1007/s00540-011-1221-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-011-1221-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Uchida Kanji Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Yasunaga Hideo Department of Health Management and Policy, Tokyo University Graduate School of Medicine, Tokyo, Japan aut NATIONALLICENCE 700 1- Miyata Hiroaki Department of Health Quality Assessment, Tokyo University Graduate School of Medicine, Tokyo, Japan aut NATIONALLICENCE 700 1- Sumitani Masahiko Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Horiguchi Hiromasa Department of Health Management and Policy, Tokyo University Graduate School of Medicine, Tokyo, Japan aut NATIONALLICENCE 700 1- Kuwajima Ken Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Matsuda Shinya Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan aut NATIONALLICENCE 700 1- Yamada Yoshitsugu Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/6(2011-12-01), 864-871 0913-8668 25:6<864 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer