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Incidence of and predictors for serious opioid-related adverse drug events
Linda Denke1, Folefac D Atem, Michael Khazzam
1At the University of Texas Southwestern Medical Center, Linda Denke is a nurse scientist and the director of nursing research, Folefac Atem is the lead statistician in the Department of Biostatistics and Data Science, and Michael Khazzam is an associate professor of Orthopedic Surgery.
Purpose:
To determine the incidence of and predictors for serious opioid-related adverse drug events (ORADEs) in postoperative inpatients.
Methods:
A retrospective cohort study design of serious ORADEs in surgical inpatients between 2015 and 2017, who were abstracted from the electronic health record, in an 800-bed academic medical health center.
Results:
A total of 27,942 surgery patients met the inclusion criteria. Of those, 25,208 patients (90%) were exposed to opioids after surgery. A total of 25,133 (99.7%) patients exposed to opioids did not experience a serious ORADE while 75 (0.3%) patients did experience a serious ORADE and required naloxone. The predictors for ORADEs include age (OR = 1.040, P-value < .0001); gender (OR = 0.394, P-value = .0006); psychiatric disorder (OR = 4.440, CI: 2.435, 8.095); morphine level with respect to hydrocodone-acetaminophen (OR = 5.841, P-value = .0384); and were almost six times more likely to experience a serious ORADE when morphine is prescribed and 4.44 times more likely in patients with a psychiatric disorder (P-value < .0001).
Conclusion:
Once a baseline incidence is known, predictors for serious ORADEs in surgical inpatients are useful in guiding medical-surgical nurses' opioid safety practices, with more frequent focused respiratory assessments before opioid dosing and closer monitoring when opioids are prescribed postoperatively, especially in higher-risk surgical inpatients.
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