Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database

PLoS One. 2016 Feb 25;11(2):e0150214. doi: 10.1371/journal.pone.0150214. eCollection 2016.

Abstract

Background: While opioid use confers a known risk for respiratory depression, the incremental risk of in-hospital cardiopulmonary arrest, respiratory arrest, or cardiopulmonary resuscitation (CPRA) has not been studied. Our aim was to investigate the prevalence, outcomes, and risk profile of in-hospital CPRA for patients receiving opioids and medications with central nervous system sedating side effects (sedatives).

Methods: A retrospective analysis of adult inpatient discharges from 2008-2012 reported in the Premier Database. Patients were grouped into four mutually exclusive categories: (1) opioids and sedatives, (2) opioids only, (3) sedatives only, and (4) neither opioids nor sedatives.

Results: Among 21,276,691 inpatient discharges, 53% received opioids with or without sedatives. A total of 96,554 patients suffered CPRA (0.92 per 1000 hospital bed-days). Patients who received opioids and sedatives had an adjusted odds ratio for CPRA of 3.47 (95% CI: 3.40-3.54; p<0.0001) compared with patients not receiving opioids or sedatives. Opioids alone and sedatives alone were associated with a 1.81-fold and a 1.82-fold (p<0.0001 for both) increase in the odds of CPRA, respectively. In opioid patients, locations of CPRA were intensive care (54%), general care floor (25%), and stepdown units (15%). Only 42% of patients survived CPRA and only 22% were discharged home. Opioid patients with CPRA had mean increased hospital lengths of stay of 7.57 days and mean increased total hospital costs of $27,569.

Conclusions: Opioids and sedatives are independent and additive risk factors for in-hospital CPRA. The impact of opioid sparing analgesia, reduced sedative use, and better monitoring on CPRA incidence deserves further study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesia / adverse effects*
  • Analgesia / methods
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Cardiopulmonary Resuscitation / statistics & numerical data*
  • Cost of Illness
  • Databases, Factual
  • Female
  • Heart Arrest / chemically induced*
  • Heart Arrest / economics
  • Heart Arrest / epidemiology*
  • Hospital Records
  • Hospitalization
  • Humans
  • Hypnotics and Sedatives / adverse effects*
  • Hypnotics and Sedatives / therapeutic use
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk
  • Risk Factors
  • Young Adult

Substances

  • Analgesics, Opioid
  • Hypnotics and Sedatives

Grants and funding

This analysis was supported by Covidien Healthcare Economics and Outcome Research. JQ, HLC, and ME are Covidien employees. The funder, Covidien, provided support in the form of salaries for authors JQ, HLC, and ME, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. FJO and JM are employed by North American Partners in Anesthesia. NM is employed by Harrier Consultancy. BH is employed by Boulder Medical Writing. North American Partners in Anesthesia, Harrier Consultancy, and Boulder Medical Writing provided support in the form of salaries for authors FJO, JM, NM, and BH, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.