Impact of Respiratory Compromise in Inpatient Interventional Radiology Procedures with Moderate Sedation in the United States

Abstract

Background Despite increased use of moderate sedation in interventional radiology (IR), patient reactions to moderate sedation are difficult to predict. The rate, risk factors, and burden of respiratory compromise in patients who undergo IR procedures with moderate sedation in the United States are poorly understood. Purpose To identify risk factors and quantify the clinical and economic burden of respiratory compromise in inpatient IR procedures in the United States. Materials and Methods Primary inpatient IR procedures with moderate sedation conducted from October 1, 2012, to September 30, 2015, were analyzed by using a retrospective claims database. Exclusions included age younger than 18 years, use of anesthesia, pre-existing cardiac or respiratory arrest, and respiratory failure. Respiratory compromise was defined as use of naloxone or flumazenil, nonmechanical or cardiopulmonary resuscitation, or endotracheal intubation on the day of the IR procedure. Propensity score matching was performed to risk adjust patients for cost and outcomes analysis, including hospital and intensive care unit (ICU) length of stay, invasive mechanical ventilation, and death before hospital discharge. Results This study analyzed 525 151 patients (mean age, 60 years ± 17 [standard deviation]; 278 576 women). Respiratory compromise occurred in 1.0% (5235 of 525 151) of patients, predicted by long-term opioid therapy or active substance abuse (odds ratio [OR], 2.7; P < .001), age 65 years or older (OR, 1.4; P < .001), and sleep apnea (OR, 1.3; P < .001). Risk-adjusted patients with respiratory compromise compared with patients without respiratory compromise had $6904 higher costs (P < .001), 1.1-day longer hospital length of stay (P < .001), and higher rates of ICU admission (69.7% [3125 of 5235] vs 25.5% [1333 of 5235], respectively; P < .001), invasive mechanical ventilation (33.6% [1758 of 5235] vs 1.6% [85 of 5235], respectively; P < .001), and death (27.1% [1421 of 5235] vs 3.2% [166 of 5235], respectively; P < .001). Conclusion In the United States, respiratory compromise in interventional radiology procedures with moderate sedation contributes to worse clinical outcomes and higher costs. Respiratory compromise risk factors including long-term opioid therapy or active substance abuse, age 65 years or older, and sleep apnea should be preassessed and used to help guide intraprocedural monitoring to prevent respiratory compromise, improve patient outcomes, and reduce costs. © RSNA, 2019 See also the editorial by Rosen and Walz in this issue. Online supplemental material is available for this article.