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Defining, Evaluating, and Managing Postoperative Respiratory Depression: An e-Delphi Study.

Sabry Ayad^1,2,3, Claudio S Pergolizzi⁴, Robert B Raffa⁵

¹Outcomes Research, Cleveland Clinic, Cleveland, USA.

|March 30, 2026

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This summary is machine-generated.

Postoperative respiratory depression (PORD) is defined by expert consensus as reduced breathing drive post-surgery. This consensus aids in standardizing PORD research, monitoring, and prevention strategies.

Area of Science:

Anesthesiology and Critical Care Medicine
Pulmonary Medicine
Surgical Complications

Background:

Postoperative respiratory depression (PORD) is a frequent, underreported complication.
Lack of a universal definition hinders PORD identification and research.

Purpose of the Study:

Establish expert consensus on a PORD definition.
Outline diagnostic criteria, risk factors, and management principles for PORD.

Main Methods:

An e-Delphi study involved 10 multidisciplinary physicians.
Four rounds of anonymous consensus-building on 20 PORD-related statements.
A ≥70% agreement threshold was used to define consensus.

Main Results:

Keywords:

anesthesia capnography delphi method expert consensus opioid-induced respiratory depression pain management patient safety perioperative monitoring postoperative pulmonary complications postoperative respiratory depression

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95% of statements achieved consensus, defining PORD by reduced breathing drive and specific vital sign thresholds within 48 hours.

Key consensus areas include risk factors, diagnosis using continuous monitoring, and need for effective reversal agents.

A consensus on low-dose naloxone infusion was not reached.

Conclusions:

Expert consensus provides a clinically applicable definition and framework for PORD.
Standardized research, perioperative monitoring, and preventive strategies are now feasible.
The need for targeted PORD reversal agents is emphasized.