Opioid-related adverse drug events in surgical patients: risk factors and association with clinical outcomes

ABSTRACT

Background

Opioid analgesics are commonly used to treat acute post-operative pain. The primary objective of this study was to identify the risk factors for opioid-related adverse drug events (ORADEs) in surgical patients and the association between ORADEs and clinical outcomes.

Research design and methods

A retrospective cohort study was conducted using data from July 2016 to April 2020. ORADEs were defined using the International Classification of Diseases 10^th Revision Australian Modification codes. Multivariate logistic regression was performed to identify ORADE risk factors. To investigate the association between ORADEs and clinical outcomes, propensity score matching was performed.

Results

Among 17,886 surgical patients who received opioid analgesics during hospital stay, 1,814 patients (10.2%) experienced ORADEs. Risk factors for general ORADEs included advanced age, comorbidities, concurrent use of benzodiazepines or gabapentinoids and a higher opioid daily dose. Patients who experienced ORADEs were associated with longer length of stay (Rate Ratio 3.00, 95% CI 2.97–3.04) but similar 28-day readmission rate (Odds Ratio 0.89, 95% CI 0.71–1.11).

Conclusions

Risk factors for general ORADEs were advanced age, specific comorbidities, use of benzodiazepines or gabapentinoids and higher opioid dose. Routine use of opioids with gabapentinoids should be avoided and only used after careful consideration.

KEYWORDS:

• Opioid
• hospital
• surgical
• adverse drug reactions

Authors’ contributions

J Penm conceived and designed the analysis. All authors contributed to refining the design of the analysis. CH Yiu collected the data, performed the analysis and wrote original draft of the paper. J Penm, D Gnjidic and A Patanwala reviewed the analysis. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript. J Penm was the primary supervisor for this research.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Ethics approval

This study was approved by the South Eastern Sydney Local Health District Human Research Ethics Committee (2019/ETH04809).

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was not funded.