Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database
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 fo...
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| creator | Overdyk, Frank J Dowling, Oonagh Marino, Joseph Qiu, Jiejing Chien, Hung-Lun Erslon, Mary Morrison, Neil Harrison, Brooke Dahan, Albert Gan, Tong J |
| description | 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).
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.
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 |
| doi_str_mv | 10.1371/journal.pone.0150214 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0150214</identifier><identifier>PMID: 26913753</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analgesia ; Analgesia - adverse effects ; Analgesia - methods ; Analgesics ; Analgesics, Opioid - adverse effects ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Anesthesiology ; Cardiac arrest ; Cardiopulmonary resuscitation ; Cardiopulmonary Resuscitation - statistics & numerical data ; Central nervous system ; Codes ; Complications and side effects ; Cost of Illness ; CPR ; Databases, Factual ; Dosage and administration ; Female ; Health care policy ; Heart Arrest - chemically induced ; Heart Arrest - economics ; Heart Arrest - epidemiology ; Hospital Records ; Hospitalization ; Hospitals ; Humans ; Hypnotics and sedatives ; Hypnotics and Sedatives - adverse effects ; Hypnotics and Sedatives - therapeutic use ; Intensive care ; Length of Stay - economics ; Male ; Medical diagnosis ; Medical prognosis ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Narcotics ; Opioids ; Pain perception ; Patient safety ; Patients ; Resuscitation ; Retrospective Studies ; Risk ; Risk analysis ; Risk assessment ; Risk Factors ; Sedatives ; Side effects ; Teams ; Young Adult</subject><ispartof>PloS one, 2016-02, Vol.11 (2), p.e0150214-e0150214</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Overdyk et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Overdyk et al 2016 Overdyk et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-ec3d7fbf03df811b184cad231de8899e2723f86cf81002bd93fa14743c936b063</citedby><cites>FETCH-LOGICAL-c692t-ec3d7fbf03df811b184cad231de8899e2723f86cf81002bd93fa14743c936b063</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767404/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767404/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26913753$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Overdyk, Frank J</creatorcontrib><creatorcontrib>Dowling, Oonagh</creatorcontrib><creatorcontrib>Marino, Joseph</creatorcontrib><creatorcontrib>Qiu, Jiejing</creatorcontrib><creatorcontrib>Chien, Hung-Lun</creatorcontrib><creatorcontrib>Erslon, Mary</creatorcontrib><creatorcontrib>Morrison, Neil</creatorcontrib><creatorcontrib>Harrison, Brooke</creatorcontrib><creatorcontrib>Dahan, Albert</creatorcontrib><creatorcontrib>Gan, Tong J</creatorcontrib><title>Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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).
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.
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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analgesia</subject><subject>Analgesia - adverse effects</subject><subject>Analgesia - methods</subject><subject>Analgesics</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Cardiac arrest</subject><subject>Cardiopulmonary resuscitation</subject><subject>Cardiopulmonary Resuscitation - statistics & numerical data</subject><subject>Central nervous system</subject><subject>Codes</subject><subject>Complications and side effects</subject><subject>Cost of Illness</subject><subject>CPR</subject><subject>Databases, Factual</subject><subject>Dosage and administration</subject><subject>Female</subject><subject>Health care policy</subject><subject>Heart Arrest - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Overdyk, Frank J</au><au>Dowling, Oonagh</au><au>Marino, Joseph</au><au>Qiu, Jiejing</au><au>Chien, Hung-Lun</au><au>Erslon, Mary</au><au>Morrison, Neil</au><au>Harrison, Brooke</au><au>Dahan, Albert</au><au>Gan, Tong J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-02-25</date><risdate>2016</risdate><volume>11</volume><issue>2</issue><spage>e0150214</spage><epage>e0150214</epage><pages>e0150214-e0150214</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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).
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26913753</pmid><doi>10.1371/journal.pone.0150214</doi><tpages>e0150214</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1771271876 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adult Aged Aged, 80 and over Analgesia Analgesia - adverse effects Analgesia - methods Analgesics Analgesics, Opioid - adverse effects Analgesics, Opioid - therapeutic use Anesthesia Anesthesiology Cardiac arrest Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - statistics & numerical data Central nervous system Codes Complications and side effects Cost of Illness CPR Databases, Factual Dosage and administration Female Health care policy Heart Arrest - chemically induced Heart Arrest - economics Heart Arrest - epidemiology Hospital Records Hospitalization Hospitals Humans Hypnotics and sedatives Hypnotics and Sedatives - adverse effects Hypnotics and Sedatives - therapeutic use Intensive care Length of Stay - economics Male Medical diagnosis Medical prognosis Medicine Medicine and Health Sciences Middle Aged Narcotics Opioids Pain perception Patient safety Patients Resuscitation Retrospective Studies Risk Risk analysis Risk assessment Risk Factors Sedatives Side effects Teams Young Adult |
| title | Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T14%3A21%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20of%20Opioids%20and%20Sedatives%20with%20Increased%20Risk%20of%20In-Hospital%20Cardiopulmonary%20Arrest%20from%20an%20Administrative%20Database&rft.jtitle=PloS%20one&rft.au=Overdyk,%20Frank%20J&rft.date=2016-02-25&rft.volume=11&rft.issue=2&rft.spage=e0150214&rft.epage=e0150214&rft.pages=e0150214-e0150214&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0150214&rft_dat=%3Cgale_plos_%3EA444268417%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1771271876&rft_id=info:pmid/26913753&rft_galeid=A444268417&rft_doaj_id=oai_doaj_org_article_a61477da392f4ca7b3c10cc1a3b401bc&rfr_iscdi=true |