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. 2018 Mar 22;13(3):e0194553.
doi: 10.1371/journal.pone.0194553. eCollection 2018.

Risk factors for cardiopulmonary and respiratory arrest in medical and surgical hospital patients on opioid analgesics and sedatives

Igor Izrailtyan  1 , Jiejing Qiu  2 , Frank J Overdyk  3 , Mary Erslon  4 , Tong J Gan  1
Affiliations

Risk factors for cardiopulmonary and respiratory arrest in medical and surgical hospital patients on opioid analgesics and sedatives

Igor Izrailtyan et al. PLoS One. .

Abstract

Background: Opioid 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.

Methods: The 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.

Results: During 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.

Conclusions: Opioids 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.

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Conflict of interest statement

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: This analysis was supported by Medtronic Healthcare Economics and Outcomes Research. JQ and ME are Medtronic employees. II and TJG received grant support for this study. FJO reports grant support and honorarium from Medtronic, unrelated to the submitted work. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

References

    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322. doi: 10.1161/CIR.0000000000000152 - DOI - PubMed
    1. Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005;67(1):75–80. doi: 10.1016/j.resuscitation.2005.03.021 - DOI - PubMed
    1. Merchant RM, Yang L, Becker LB, Berg RA, Nadkarni V, Nichol G, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States. Critical care medicine. 2011;39(11):2401–6. doi: 10.1097/CCM.0b013e3182257459 - DOI - PMC - PubMed
    1. Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, et al. Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S397–413. - PubMed
    1. Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PW Jr., et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation. 2013;127(14):1538–63. doi: 10.1161/CIR.0b013e31828b2770 - DOI - PubMed

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