Abstract
BackgroundOpioid induced respiratory depression is a known cause of preventable death in hospitals. Medications with sedative properties additionally potentiate opioid-induced respiratory and sedative effects, thereby elevating the risk for adverse events. The goal of this study was to determine what specific factors increase the risk of in-hospital cardiopulmonary and respiratory arrest (CPRA) in medical and surgical patients on opioid and sedative therapy.MethodsThe present study analyzed 14,504,809 medical inpatient and 6,771,882 surgical inpatient discharges reported into the Premier database from 2008 to 2012. Patients were divided in four categories: on opioids; on sedatives; on both opioids and sedatives; and on neither opioids nor sedatives.ResultsDuring hospital admission, 57% of all medical patients and 90% of all surgical patients were prescribed opioids, sedatives, or both. Surgical patients had a higher incidence of CPRA than medical patients (6.17 vs. 3.77 events per 1000 admissions; Relative Risk: 1.64 [95%CI: 1.62–1.66; p<0.0001). Opioids and sedatives were found to be independent predictors of CPRA (adjusted OR of 2.24 [95%CI: 2.18–2.29] for opioids and adjusted OR 1.80 [95%CI: 1.75–1.85] for sedatives in medical patients, and adjusted OR of 1.12 [95%CI: 1.07–1.16] for opioids and adjusted OR of 1.58 [95%CI: 1.51–1.66] for sedatives in surgical patients), with the highest risk in groups who received both types of medications (adjusted OR of 3.83 [95% CI: 3.74–3.92] in medical patients, and adjusted OR of 2.34 [95% CI: 2.25–2.42] in surgical patients) compared with groups that received neither type of medication. The common risk factors of CPRA in medical and surgical patients receiving both opioids and sedatives were Hispanic origin, mild liver disease, obesity, and COPD. Additionally, medical and surgical groups had their own unique risk factors for CPRA when placed on opioid and sedative therapy.ConclusionsOpioids and sedatives are independent and additive predictors of CPRA in both medical and surgical patients. Receiving both classes of medications further exacerbates the risk of CPRA for these patients. By identifying groups at risk among medical and surgical in-hospital patients, this study provides a step towards improving our understanding of how to use opioid and sedative medications safely, which may influence our treatment strategies and outcomes. More precise monitoring of selected high-risk patients may help prevent catastrophic cardiorespiratory complications from these medications. As a retrospective administrative database analysis, this study does not establish the causality or the temporality of the events but rather draws statistically significant associations between the clinical factors and outcomes.
Highlights
Cardiopulmonary arrest remains a prominent public health burden in developed countries [1, 2]
Surgical patients had a higher incidence of cardiopulmonary and respiratory arrest (CPRA) than medical patients (6.17 vs. 3.77 events per 1000 admissions; Relative Risk: 1.64 [95% CI: 1.62–1.66; p
Opioids and sedatives were found to be independent predictors of CPRA, with the highest risk in groups who received both types of medications compared with groups that received neither type of medication
Summary
Cardiopulmonary arrest remains a prominent public health burden in developed countries [1, 2]. With over half a million cardiac arrests occurring in the United States each year, over 200,000 of them take place in hospitals [1, 3]. While both the in-hospital cardiac arrest (IHCA) and out-of hospital cardiac arrest (OHCA) share similarities, they are very different entities [4,5,6]. Recognizing the different challenges faced by primary providers for IHCA and OHCA events, the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care have emphasized the need for two distinct pathways of care required to manage these two patient populations [4]. The goal of this study was to determine what specific factors increase the risk of in-hospital cardiopulmonary and respiratory arrest (CPRA) in medical and surgical patients on opioid and sedative therapy
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