Opioid-induced respiratory depression increases hospital costs and length of stay in patients recovering on the general care floor

Wolfgang Buhre,Hiroshi Morimatsu,Wei Jiang,Carla R. Jungquist,Leif Saager,Lian Kah Ti,Sergio D. Bergese,Roy Soto,Ashish K. Khanna,Shoichi Uezono

doi:10.1186/s12871-021-01307-8

Abstract

BackgroundOpioid-induced respiratory depression is common on the general care floor. However, the clinical and economic burden of respiratory depression is not well-described. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial created a prediction tool to identify patients at risk of respiratory depression. The purpose of this retrospective sub-analysis was to examine healthcare utilization and hospital cost associated with respiratory depression.MethodsOne thousand three hundred thirty-five patients (N = 769 United States patients) enrolled in the PRODIGY trial received parenteral opioids and underwent continuous capnography and pulse oximetry monitoring. Cost data was retrospectively collected for 420 United States patients. Differences in healthcare utilization and costs between patients with and without ≥1 respiratory depression episode were determined. The impact of respiratory depression on hospital cost per patient was evaluated using a propensity weighted generalized linear model.ResultsPatients with ≥1 respiratory depression episode had a longer length of stay (6.4 ± 7.8 days vs 5.0 ± 4.3 days, p = 0.009) and higher hospital cost ($21,892 ± $11,540 vs $18,206 ± $10,864, p = 0.002) compared to patients without respiratory depression. Patients at high risk for respiratory depression, determined using the PRODIGY risk prediction tool, who had ≥1 respiratory depression episode had higher hospital costs compared to high risk patients without respiratory depression ($21,948 ± $9128 vs $18,474 ± $9767, p = 0.0495). Propensity weighted analysis identified 17% higher costs for patients with ≥1 respiratory depression episode (p = 0.007). Length of stay significantly increased total cost, with cost increasing exponentially for patients with ≥1 respiratory depression episode as length of stay increased.ConclusionsRespiratory depression on the general care floor is associated with a significantly longer length of stay and increased hospital costs. Early identification of patients at risk for respiratory depression, along with early proactive intervention, may reduce the incidence of respiratory depression and its associated clinical and economic burden.Trial registrationClinicalTrials.gov, NCT02811302.

Highlights

Opioid-induced respiratory depression is common on the general care floor
The international PRediction of Opioidinduced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial identified a 46% incidence of opioid-induced respiratory depression episodes among post-surgical and medical patients receiving opioids on the general care floor [4]
Trial cohort Of the 1335 patients enrolled in the PRODIGY trial who started continuous monitoring and received opioid therapy on the general care floor, healthcare utilization data was collected and analyzed for 769 patients in the United States (Fig. 1)

Summary

Introduction

Opioid-induced respiratory depression is common on the general care floor. the clinical and economic burden of respiratory depression is not well-described. Respiratory depression, if defined by hypoxemia, occurs in up to a fifth of all continuously monitored patients for at least an hour of duration of recovery after non-cardiac surgery on the general care floor [5] These are not benign occurrences, but may be associated with a series of adverse events [4, 6,7,8,9,10,11,12]. Kessler and colleagues showed that from an initial cohort of 36,529 patients, 98.6% received opioids, and 13.6% patients with an ORADE had a 55% longer length of stay, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality than patients who did not experience an ORADE [14] This extent of clinical burden is supported by other literature as well [11, 16,17,18,19,20]. Need for postoperative oxygen as a surrogate for opioid-induced respiratory depression in the post-anesthesia care unit is associated with significant increases in day of surgery charges, respiratory charges, total charges, hospital length of stay, reintubation, and use of invasive or noninvasive ventilatory support [21]

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