04:03 PM Abstract No. 40 The clinical and economic burden of respiratory compromise in inpatient interventional radiology procedures with procedural sedation

Abstract

Use of procedural sedation (PS) is rising due to the increasing complexity of interventional radiology (IR) procedures and comorbid patient populations. Patient’s response to PS is often difficult to predict. There are few studies reporting on the burden of respiratory compromise (RC) in IR. The aim was to identify the incidence, risk factors, and burden of RC in all types of inpatient IR procedures. A retrospective 3-year Premier® analysis was performed in adult inpatients undergoing any IR procedure with PS (IR-PS) as primary admission procedure. RC events were defined as using reversal agents (naloxone, flumazenil), nonmechanical or cardiopulmonary resuscitation, or endotracheal intubation on the same day of IR-PS. Cases with general anesthesia and pre-existing cardiac and respiratory diagnoses were excluded. A 1:1 propensity score matching was used for cost and utilization analysis. RC events were observed in 5,235 of 525,151 (1%) IR procedures. Patients who were 65 years of age or older, admitted for urgent/emergent care, obese, and had sleep apnea or history of opioid therapy/ active substance abuse had a higher risk of RC. Gender, presence of chronic pain, or low vs. high relative value unit (RVU) procedures were not RC predictors. RC patients were associated with greater use of invasive mechanical ventilation (IMV), longer overall length of stay (LOS) and ICU LOS, and higher death rates than non-RC patients. RC patients also had higher total admission and ICU cost. Results are summarized in Table 1. Certain factors may put patients at a greater risk of developing RC during IR-PS. RC patients appear to have worse outcomes and higher cost of care. Strategies to prevent and manage RC events in IR are needed.Table 1Odd RatiosP ValueRC Predictors Prior opioid therapy2.685<0.0001 >65 yr of age1.4260.0071 Sleep apnea1.251<0.0001 Urgent or emergent care1.1280.0071 Obesity1.1020.0185Not RC Predictors Male vs. female0.9680.2426 Low vs. high RVU0.9620.38 Chronic pain0.9330.183RCNo RCP ValueClinical Outcomes IMV use33.58%1.62%<0.0001 Death rate27.14%3.17% Overall LOS (μ, days)8.47.3 ICU LOS (μ, days)4.33.4Costs (μ) Total admission$23,231$16,328<0.0001 ICU$7898$5936 Open table in a new tab