title: How Drug Shortages Affect Clinical Care: The Case of the Surgical Anesthetic Propofol.
abstract: BACKGROUND
  Periodic drug shortages have become a reality in clinical practice. In 2010, in the context of a nationwide drug shortage, our hospital experienced an abrupt 3-month shortage of the surgical anesthetic propofol. The purpose of this retrospective study was to survey the clinical impact of the abrupt propofol shortage at our hospital and to survey for any change in perioperative mortality.
  
  
  METHODS
  A retrospective before-and-after analysis, comparing May through July 2010 (group A, prior to the propofol shortage) to August through October 2010 (group B, during the propofol shortage).
  
  
  RESULTS
  In May through July 2010, before the propofol shortage, a majority of patients (80%) received propofol (group A, n = 2,830). In August through October 2010, during the propofol shortage, a majority of patients (81%) received etomidate (group B, n = 3,066). We observed that net usage of etomidate increased by more than 600% in our hospital. Baseline health characteristics and type of surgery were similar between groups A and B. Thirty-day and 2-year mortality were similar between groups A and B. The reported causes and frequency of mortality in groups A and B were also similar.
  
  
  CONCLUSIONS
  The propofol shortage led to an increased usage of etomidate by more than 600%. In spite of that, we did not detect an increase in mortality associated with the increased use of etomidate during a 3-month propofol shortage.
authors.affiliation: Department of Anesthesiology & Pain Management, UT-Southwestern Medical Center , Dallas, Texas.
authors.forename: Bryan
authors.initials: B
authors.lastname: Romito
authors.affiliation: UT-Southwestern School of Medicine , Dallas, Texas .
authors.forename: Jonathan
authors.initials: J
authors.lastname: Stone
authors.affiliation: UT-Southwestern School of Medicine , Dallas, Texas .
authors.forename: Ning
authors.initials: N
authors.lastname: Ning
authors.affiliation: UT-Southwestern School of Medicine , Dallas, Texas .
authors.forename: Chen
authors.initials: C
authors.lastname: Yin
authors.affiliation: UT-Southwestern School of Medicine , Dallas, Texas .
authors.forename: Ernesto M
authors.initials: EM
authors.lastname: Llano
authors.affiliation: UT-Southwestern School of Medicine , Dallas, Texas .
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: UT-Southwestern School of Medicine , Dallas, Texas .
authors.forename: Keerthan
authors.initials: K
authors.lastname: Somanath
authors.affiliation: Department of Anesthesiology & Pain Management, UT-Southwestern Medical Center , Dallas, Texas.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology & Pain Management, UT-Southwestern Medical Center , Dallas, Texas.
authors.forename: Gerald
authors.initials: G
authors.lastname: Matchett
keywords: drug shortage; etomidate; induction of anesthesia; intravenous anesthetics, propofol