Home Monitoring of High-Risk Individuals Receiving Opioids Post Orthopedic Surgery

Area of Science:

• Medical Monitoring
• Respiratory Medicine
• Orthopedic Surgery

Background:

• Opioid-induced respiratory depression (OIRD) poses risks for postoperative patients.
• Current guidelines recommend electronic monitoring during hospitalization for OIRD.
• The effectiveness of home monitoring after ambulatory surgery remains unassessed.

Purpose of the Study:

• Assess patient and caregiver acceptance of home monitoring for OIRD post-orthopedic surgery.
• Determine the incidence of OIRD and related morbidity after discharge.
• Evaluate patient understanding of OIRD risks.

Main Methods:

• Prospective quality improvement initiative involving 359 ambulatory orthopedic surgery patients.
• Home cardiorespiratory monitoring using a commercial device for 4 days post-discharge.
• Analysis of end-tidal carbon dioxide pressure (PETCO2), SpO2, respiratory rate, and heart rate.

Main Results:

• 70% of patients received supplemental oxygen post-discharge.
• 26 subjects (7.2%) visited the ED due to low SpO2 alarms.
• 14 subjects (3.9%) were diagnosed with clinically relevant opioid-induced events; one received naloxone.

Conclusions:

• Home monitoring of oxygenation (SpO2) is feasible for detecting OIRD after ambulatory orthopedic surgery.
• Respiration monitoring (PETCO2) via home devices showed limited utility in this cohort.
• Home monitoring may help identify patients at risk for adverse postoperative outcomes.