title: Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, United States of America.|North American Partners in Anesthesia, Melville, NY, United States of America.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Overdyk
authors.affiliation: Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, United States of America.
authors.forename: Oonagh
authors.initials: O
authors.lastname: Dowling
authors.affiliation: Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, United States of America.|North American Partners in Anesthesia, Melville, NY, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Marino
authors.affiliation: Covidien Healthcare Economics and Outcomes Research, Mansfield, MA, United States of America.
authors.forename: Jiejing
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Covidien Healthcare Economics and Outcomes Research, Mansfield, MA, United States of America.
authors.forename: Hung-Lun
authors.initials: HL
authors.lastname: Chien
authors.affiliation: Covidien Respiratory and Monitoring Solutions, Boulder, CO, United States of America.
authors.forename: Mary
authors.initials: M
authors.lastname: Erslon
authors.affiliation: Harrier Consultancy, Lancaster, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Morrison
authors.affiliation: Boulder Medical Writing, Boulder, CO, United States of America.
authors.forename: Brooke
authors.initials: B
authors.lastname: Harrison
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Dahan
authors.affiliation: Department of Anesthesiology, Stony Brook University (SUNY), Stony Brook, NY, United States of America.
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000009:adverse effects* / Q000379:methods; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000191:economics / Q000453:epidemiology*; D006753:Hospital Records; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives