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Journal of Pain & Palliative Care Pharmacotherapy Volume 33, 2019 - Issue 3-4
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Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden

Gary M. Oderda Gary M. Oderda, Pharm D, MPH, are with the College of Pharmacy, University of Utah, Salt Lake City, Utah, USA; Anthony J. Senagore, MD, are with the Homer Stryker School of Medicine, Borgess Medical Center/Western Michigan University, Kalamazoo, Michigan, USA; Kellie Morland, Marla Kugel, MS, MPH and Sizhu Liu, MS, are with theXcenda, LLC, Palm Harbor, Florida, USA; Sheikh Usman Iqbal, MD, MPH, MBA, are with the Trevena, Inc, Chesterbrook, Pennsylvania, USA; Ashraf S. Habib, MD, are with the Duke University Medical Center, Durham, North Carolina, USA.Correspondence[email protected]
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Anthony J. Senagore Gary M. Oderda, Pharm D, MPH, are with the College of Pharmacy, University of Utah, Salt Lake City, Utah, USA; Anthony J. Senagore, MD, are with the Homer Stryker School of Medicine, Borgess Medical Center/Western Michigan University, Kalamazoo, Michigan, USA; Kellie Morland, Marla Kugel, MS, MPH and Sizhu Liu, MS, are with theXcenda, LLC, Palm Harbor, Florida, USA; Sheikh Usman Iqbal, MD, MPH, MBA, are with the Trevena, Inc, Chesterbrook, Pennsylvania, USA; Ashraf S. Habib, MD, are with the Duke University Medical Center, Durham, North Carolina, USA.View further author information
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Kellie Morland Gary M. Oderda, Pharm D, MPH, are with the College of Pharmacy, University of Utah, Salt Lake City, Utah, USA; Anthony J. Senagore, MD, are with the Homer Stryker School of Medicine, Borgess Medical Center/Western Michigan University, Kalamazoo, Michigan, USA; Kellie Morland, Marla Kugel, MS, MPH and Sizhu Liu, MS, are with theXcenda, LLC, Palm Harbor, Florida, USA; Sheikh Usman Iqbal, MD, MPH, MBA, are with the Trevena, Inc, Chesterbrook, Pennsylvania, USA; Ashraf S. Habib, MD, are with the Duke University Medical Center, Durham, North Carolina, USA.View further author information
,
Sheikh Usman Iqbal Gary M. Oderda, Pharm D, MPH, are with the College of Pharmacy, University of Utah, Salt Lake City, Utah, USA; Anthony J. Senagore, MD, are with the Homer Stryker School of Medicine, Borgess Medical Center/Western Michigan University, Kalamazoo, Michigan, USA; Kellie Morland, Marla Kugel, MS, MPH and Sizhu Liu, MS, are with theXcenda, LLC, Palm Harbor, Florida, USA; Sheikh Usman Iqbal, MD, MPH, MBA, are with the Trevena, Inc, Chesterbrook, Pennsylvania, USA; Ashraf S. Habib, MD, are with the Duke University Medical Center, Durham, North Carolina, USA.View further author information
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Marla Kugel Gary M. Oderda, Pharm D, MPH, are with the College of Pharmacy, University of Utah, Salt Lake City, Utah, USA; Anthony J. Senagore, MD, are with the Homer Stryker School of Medicine, Borgess Medical Center/Western Michigan University, Kalamazoo, Michigan, USA; Kellie Morland, Marla Kugel, MS, MPH and Sizhu Liu, MS, are with theXcenda, LLC, Palm Harbor, Florida, USA; Sheikh Usman Iqbal, MD, MPH, MBA, are with the Trevena, Inc, Chesterbrook, Pennsylvania, USA; Ashraf S. Habib, MD, are with the Duke University Medical Center, Durham, North Carolina, USA.View further author information
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Sizhu Liu Gary M. Oderda, Pharm D, MPH, are with the College of Pharmacy, University of Utah, Salt Lake City, Utah, USA; Anthony J. Senagore, MD, are with the Homer Stryker School of Medicine, Borgess Medical Center/Western Michigan University, Kalamazoo, Michigan, USA; Kellie Morland, Marla Kugel, MS, MPH and Sizhu Liu, MS, are with theXcenda, LLC, Palm Harbor, Florida, USA; Sheikh Usman Iqbal, MD, MPH, MBA, are with the Trevena, Inc, Chesterbrook, Pennsylvania, USA; Ashraf S. Habib, MD, are with the Duke University Medical Center, Durham, North Carolina, USA.View further author information
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Ashraf S. Habib Gary M. Oderda, Pharm D, MPH, are with the College of Pharmacy, University of Utah, Salt Lake City, Utah, USA; Anthony J. Senagore, MD, are with the Homer Stryker School of Medicine, Borgess Medical Center/Western Michigan University, Kalamazoo, Michigan, USA; Kellie Morland, Marla Kugel, MS, MPH and Sizhu Liu, MS, are with theXcenda, LLC, Palm Harbor, Florida, USA; Sheikh Usman Iqbal, MD, MPH, MBA, are with the Trevena, Inc, Chesterbrook, Pennsylvania, USA; Ashraf S. Habib, MD, are with the Duke University Medical Center, Durham, North Carolina, USA.View further author information
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Pages 82-97 | Received 18 Feb 2019, Accepted 05 Sep 2019, Published online: 14 Oct 2019
 
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Abstract

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.

Additional information

Funding

This study was sponsored by Trevena, Inc. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

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