Opioids, Sedatives, and the Risk for Cardiopulmonary and Respiratory Arrest

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For this study, researchers conducted a retrospective database analysis of 14,504,809 medical and 6,771,882 surgical inpatient discharges.
For this study, researchers conducted a retrospective database analysis of 14,504,809 medical and 6,771,882 surgical inpatient discharges.

Opioids and sedatives may represent independent and additive predictors of cardiopulmonary and respiratory arrest (CPRA) in people undergoing medical or surgical procedures, according to a study published in PLoS One.

For this study, researchers conducted a retrospective database analysis of 14,504,809 medical (mean age, 57.7 years) and 6,771,882 surgical (mean age, 56.4 years) inpatient discharges reported between 2008 and 2012. Each patient was placed in 1 of 4 groups, based on medications administered: opioids, sedatives, opioids plus sedatives, and neither opioids nor sedatives.

Opioids, sedatives, or both were prescribed for 8,251,842 (57%) of all patients and for 90% of patients undergoing surgical procedures. The incidence of CPRA was higher in people undergoing surgical vs medical procedures (6.17 vs 3.77 events per 1000 admissions, respectively; relative risk, 1.64; P <.0001).

The rate of CPRA was higher in those undergoing medical or surgical procedures who received both opioids and sedatives vs neither medication (medical procedures: 2.08 vs 7.54 per 1000 admissions, respectively; surgical procedures 9.59 vs 5.30 per 1000 admissions, respectively).

A multivariable logistic regression analysis indicated that opioids and sedatives — separately and in combination — in this cohort are independent predictors of CPRA (P <.0001 for all). In people undergoing either a medical or a surgical procedure, the use of opioids or sedatives alone was an independent predictor of CPRA (people undergoing a medical procedure and receiving opioids: adjusted odds ratios [aOR], 2.24; 95% CI, 2.18-2.29; people undergoing a medical procedure and receiving sedatives: aOR, 1.80; 95% CI, 1.75-1.85; people undergoing a surgical procedure and receiving opioids: aOR, 1.12; 95% CI, 1.07-1.16; people undergoing a surgical procedure and receiving sedatives: aOR, 1.58; 95% CI, 1.51-1.66).

For patients undergoing a medical or surgical procedure, those receiving both types of medication were at a greater risk for CPRA (people undergoing a medical procedure: aOR 3.83; 95% CI, 3.74-3.92; people undergoing a surgical procedure: aOR 2.34; 95% CI, 2.25-2.42).

Other identified risk factors for CPRA in people undergoing either a medical or surgical procedure and receiving both opioid and sedative treatment include Hispanic ethnicity, mild liver disease, obesity, and chronic obstructive pulmonary disease.

Study limitations include an inability to establish causality or temporality of CPRA events and the possibility that some clinical data may have been missed because a retrospective analysis of administrative databases was used.

“Using the risk stratification identified by this study, judicious use of the combination of opioids with sedative medications, opioid-sparing analgesic techniques, and more precise monitoring of selected high-risk patients may help prevent these catastrophic events,” concluded the study authors.

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Reference

Izrailtyan I, Qiu J, Overdyk F, Eslon M, Gan T. Risk factors for cardiopulmonary and respiratory arrest in medical and surgical hospital patients on opioid analgesics and sedatives PLoS One. 2018;13:e0194553.

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