Prevalence of meperidine use in older surgical patients.
OBJECTIVE
The unique toxic and adverse effects of meperidine hydrochloride have prompted a number of expert panels convened by national health care policy organizations to recommend that meperidine not be used in older patients. We hypothesized that the prescription of meperidine was less likely to reflect these recommendations in older surgical patients than in older medical patients. The current study examined the use of meperidine in 2 urban hospitals as 1 quality indicator of the care of older adults, measuring the prevalence of its use and characteristics of the patients to whom it is administered.


METHODS
Retrospective analysis.


METHODS
Two urban hospitals: a large private tertiary care teaching hospital and a smaller academically affiliated Veterans Affairs medical center.


METHODS
Patients 65 years or older and hospitalized on medical and surgical services between February 19, 2001, and February 14, 2003.


METHODS
Patient demographics, medication administration, and department of admitting physician.


RESULTS
Meperidine was administered to approximately 1 in 8 older surgical patients at both institutions. Surgical patients were more likely than medical patients to receive a dose of meperidine (hospital A, 12.2% vs 4.3%, P<.001; hospital B, 12.9% vs 1.9%, P<.001). Of those administered meperidine, surgical patients were also more likely than medical patients to receive multiple doses (hospital A, 86.0% vs 65.5%, P = .045; hospital B, 73.8% vs 48.4%, P = .02).


CONCLUSIONS
Contrary to national recommendations, meperidine continues to be administered to many hospitalized older adults, particularly those on surgical services. Several alternatives to meperidine exist that provide equal or better pain relief with fewer toxic effects. Hospitals and, in particular, departments of surgery should address this cause of preventable morbidity in this vulnerable population.
Kornitzer
Benjamin S
BS
The Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA.
Manace
Leslie C
LC
Fischberg
Daniel J
DJ
Leipzig
Rosanne M
RM
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008614:Meperidine / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
D000701:Analgesics, Opioid; D008614:Meperidine