title: Impact of remifentanil introduction on practice patterns in general anesthesia.
abstract: OBJECTIVE
  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.
authors: Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. UCHIDAK-ANE@h.u-tokyo.ac.jp
authors: Kanji
authors: K
authors: Uchida
authors: Hideo
authors: H
authors: Yasunaga
authors: Hiroaki
authors: H
authors: Miyata
authors: Masahiko
authors: M
authors: Sumitani
authors: Hiromasa
authors: H
authors: Horiguchi
authors: Ken
authors: K
authors: Kuwajima
authors: Shinya
authors: S
authors: Matsuda
authors: Yoshitsugu
authors: Y
authors: Yamada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000191:economics / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000191:economics / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009609:Nitrous Oxide / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage* / Q000191:economics; D011184:Postoperative Period; D000077208:Remifentanil; D055815:Young Adult
chemical_list: D010880:Piperidines; D009609:Nitrous Oxide; D000077208:Remifentanil