Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden

Opioid-induced respiratory depression (OIRD) and postoperative nausea and vomiting (PONV) are challenging, resource-intensive, and costly opioid-related adverse events (ORAEs). Utilizing the Premier Healthcare Database, we identified patients > 18 years old, who underwent at least one surgical procedure of interest (i.e., cardiothoracic/vascular, general/colorectal, obstetric/gynecologic, orthopedic, or urologic), and received at least one dose of intravenous morphine, hydromorphone, or fentanyl for acute postoperative pain. The incidence of OIRD and PONV using ICD-9 codes, factors influencing these AEs, length of stay (LOS) and related costs were analyzed. Among 592,127 inpatient stays, rates of respiratory depression ranged from 3% (obstetric/gynecologic) to 17% (cardiothoracic/vascular) and nausea/vomiting from 44% (obstetric/gynecologic) to 72% (general/colorectal). Increased odds of OIRD were associated with older age (cardiothoracic/vascular, general/colorectal, obstetric/gynecologic); obesity, respiratory conditions, and sleep apnea (all surgery groups); opioid dose (cardiothoracic/vascular, general/colorectal, orthopedic); and sedative use after day 1. Increased odds of PONV were associated with younger age, female sex, and major disease severity. When respiratory depression or nausea/vomiting was present versus absent, LOS was significantly longer, and hospital costs were higher. In this analysis, OIRD and PONV were more prevalent than previously reported, were associated with identifiable risk factors, and had substantial effects on resource utilization and costs.

阿片类药物诱发的呼吸抑制（Opioid-induced respiratory depression, OIRD）与术后恶心呕吐（postoperative nausea and vomiting, PONV）均为棘手、耗费医疗资源且成本高昂的阿片类药物相关不良事件（opioid-related adverse events, ORAEs）。本研究依托普里米尔医疗数据库（Premier Healthcare Database），筛选出年龄大于18岁、接受过至少1项目标手术（即心胸/血管外科、普外科/结直肠外科、妇产科、骨科或泌尿外科手术）且因急性术后疼痛接受过至少1剂静脉注射吗啡、氢吗啡酮或芬太尼的患者。研究采用国际疾病分类第9版（ICD-9）编码，分析了OIRD与PONV的发生率、影响上述不良事件的危险因素、住院时长（length of stay, LOS）及相关医疗成本。在592127例住院病例中，呼吸抑制的发生率范围为3%（妇产科手术组）至17%（心胸/血管外科手术组），恶心呕吐的发生率范围为44%（妇产科手术组）至72%（普外科/结直肠外科手术组）。OIRD的发病风险升高与以下因素相关：年龄增长（心胸/血管外科、普外科/结直肠外科、妇产科手术组）、肥胖、呼吸系统疾病与睡眠呼吸暂停（所有手术组）、阿片类药物使用剂量（心胸/血管外科、普外科/结直肠外科、骨科手术组）以及术后首日之后使用镇静剂。PONV的发病风险升高则与年龄较小、女性性别及基础疾病严重程度较高相关。与未发生呼吸抑制或恶心呕吐的病例相比，出现上述不良事件的患者住院时长显著更长，住院成本也更高。本分析显示，OIRD与PONV的患病率高于既往报道，且与可识别的危险因素相关，同时对医疗资源利用与成本产生了显著影响。