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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Postoperative opioid-induced respiratory depression (POIRD) is a significant cause of perioperative morbidity and mortality.
  • Effective risk stratification tools for POIRD are needed to improve patient outcomes.
  • Existing validated opioid assessment tools may help identify patients at risk.

Purpose of the Study:

  • To evaluate if 3 pre-existing validated opioid tools could assess POIRD risk in patients discharged from the PACU to hospital floors.
  • To identify specific risk factors associated with POIRD in this patient population.

Main Methods:

  • Retrospective case-control study of 126 matched patients.
  • Exclusion of patients with active trauma or burns.
  • Primary endpoint: escalation of care for respiratory failure (with or without naloxone); secondary endpoint: escalation of care regardless of naloxone use.

Main Results:

  • No association found between the 3 evaluated opioid tools and POIRD or escalation of care.
  • Bipolar disorder (OR 3.68) and history of substance abuse (OR 26.33) were significant risk factors for escalation of care.
  • History of substance abuse was significantly associated with POIRD (naloxone administration, OR=6.886).

Conclusions:

  • Current opioid assessment tools were not effective in stratifying POIRD risk in this study.
  • Patients with bipolar disorder and a history of substance abuse are at increased risk for postoperative respiratory failure.
  • A history of substance abuse is a significant risk factor specifically associated with POIRD.