Postoperative day one: a high risk period for respiratory events.
BACKGROUND
In 2001, the Joint Commission on Accreditation of Healthcare Organizations released Pain Management Standards that has led to an increased focus on pain control. Since then the Institute for Safe Medication Practices has noted that overaggressive pain management has led to increases in oversedation and fatal respiratory depression. One of our previous studies found that postoperative patients may be reaching dangerously high levels of sedation as a result of pain management. Our hypothesis is that postoperative patients who have a respiratory event caused by analgesic use are more likely to have that event in the first postoperative day.


METHODS
We performed a retrospective case-control analysis identifying 62 postoperative patients who had a respiratory event. A respiratory event was defined as respiratory depression caused by narcotic use in the postoperative period that was reversed by naloxone. Sixty-two postoperative patients with no such event were chosen randomly and frequency matched based on surgical procedure and diagnosis-related group. Risk factors for an event were identified.


RESULTS
Of the cases, 77.4% had a respiratory event in the first 24 hours postoperatively. Significant risk factors for an event were as follows: 65 years of age or older, having chronic obstructive pulmonary disease, having 1 or more comorbidities, and being placed on hydromorphone.


CONCLUSIONS
The first 24 hours after surgery represents a high-risk period for a respiratory event as a result of narcotic use. The realization of this risk can lead to the implementation of standards to increase patient safety in the first postoperative day.
Taylor
Shiv
S
Department of Surgery, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
Kirton
Orlando C
OC
Staff
Ilene
I
Kozol
Robert A
RA
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D004091:Hydromorphone / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D016017:Odds Ratio; D010149:Postoperative Pain / Q000188:drug therapy; D011184:Postoperative Period; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D000701:Analgesics, Opioid; D009020:Morphine; D004091:Hydromorphone; D005283:Fentanyl