title: Incidence and Demographics of Post-Operative Naloxone Administration: A 13-Year Experience at a Major Tertiary Teaching Institution.
abstract: BACKGROUND
  Perioperative use of opioids is associated with the risk of opioid-induced respiratory depression. Naloxone is a competitive opioid antagonist typically administered to reverse opioid-induced respiratory depression. Postoperative administration of naloxone may be considered a proxy for significant postoperative opioid-induced respiratory depression and data regarding its use may be utilized as a quality measure. Few large studies have been done to characterize the population and define an incidence of naloxone recipients in the postoperative inpatient setting.
  
  
  OBJECTIVE
  We aimed to characterize the demographics of patients receiving postoperative naloxone, as well as the incidence of administration in the first 72 post-operative hours at a large urban academic medical center in the United States.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  Major urban tertiary teaching institution.
  
  
  METHODS
  The robust electronic record database of The Department of Anesthesiology at The Icahn School of Medicine at Mount Sinai, as well as the institution's data warehouse were instrumental in allowing almost 450,000 surgical cases performed between 2001 and 2014 to be screened for naloxone administration within the first 72 postoperative hours. Organ harvests, outside of OR intubations, cancelled cases, and patients age less than or equal to 18 were excluded from the total case count.
  
  
  RESULTS
  Naloxone was administered 433 times in a total of 442,699 postoperative cases. This yielded an incidence of 0.1%. Additionally, the demographics of the group receiving naloxone were described. The mean age was 60, mean body mass index (BMI) was 27, 60% were women, and the mean American Society of Anesthesiologists (ASA) status was 3. Average time to naloxone administration was 21 hours (standard deviation 7) after surgery. Thirteen percent of the cases were emergent. Breakdown of anesthetic technique revealed that 81% of the cases were performed under general anesthesia, 7% with monitored anesthesia care (MAC), and 12% under neuraxial anesthesia. This study lays the groundwork for further elucidating risk factors for postoperative administration of naloxone.
  
  
  CONCLUSIONS
  This is a retrospective study.
  
  
  CONCLUSIONS
  The overall incidence of postoperative naloxone administration over a 13 year period in approximately 450,000 patients was 0.1%. Demographics of this group were older, ASA 3 women, qualifying as overweight, but not obese, undergoing elective surgery with a general anesthetic technique. Average time to administration was 21 hours postoperatively.
authors.forename: Yury
authors.initials: Y
authors.lastname: Khelemsky
authors.affiliation: Icahn School of Medicine at Mount Sinai Department of Anesthesiology Division of Pain Medicine, New York, NY.
authors.forename: Rishi
authors.initials: R
authors.lastname: Kothari
authors.affiliation: Icahn School of Medicine at Mount Sinai Department of Anesthesiology Division of Pain Medicine, New York, NY.
authors.forename: Neville
authors.initials: N
authors.lastname: Campbell
authors.affiliation: Icahn School of Medicine at Mount Sinai Department of Anesthesiology Division of Pain Medicine, New York, NY.
authors.forename: Shahbaz
authors.initials: S
authors.lastname: Farnad
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000139:chemically induced / Q000188:drug therapy*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone