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Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

OBJECTIVE: This systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD). DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Control...

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Autores principales: Gupta, Kapil, Nagappa, Mahesh, Prasad, Arun, Abrahamyan, Lusine, Wong, Jean, Weingarten, Toby N, Chung, Frances
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303633/
https://www.ncbi.nlm.nih.gov/pubmed/30552274
http://dx.doi.org/10.1136/bmjopen-2018-024086
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author Gupta, Kapil
Nagappa, Mahesh
Prasad, Arun
Abrahamyan, Lusine
Wong, Jean
Weingarten, Toby N
Chung, Frances
author_facet Gupta, Kapil
Nagappa, Mahesh
Prasad, Arun
Abrahamyan, Lusine
Wong, Jean
Weingarten, Toby N
Chung, Frances
author_sort Gupta, Kapil
collection PubMed
description OBJECTIVE: This systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD). DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed and Clinicaltrials.gov (January 1946 to November 2017). ELIGIBILITY CRITERIA: The inclusion criteria were: (1) adult patients 18 years or older who were administered opioids after surgery and developed postoperative OIRD (OIRD group); (2) all studies which reported both OIRD events and associated risk factors; (3) all studies with reported data for each risk factor on patients with no OIRD (control group) and (4) published articles in English language. DATA ANALYSIS: We used a random effects inverse variance analysis to evaluate the existing evidence of risk factors associated with OIRD. Newcastle-Ottawa scale scoring system was used to assess quality of study. RESULTS: Twelve observational studies were included from 8690 citations. The incidence of postoperative OIRD was 5.0 cases per 1000 anaesthetics administered (95% CI: 4.8 to 5.1; total patients: 841 424; OIRD: 4194). Eighty-five per cent of OIRD occurred within the first 24 hours postoperatively. Increased risk for OIRD was associated with pre-existing cardiac disease (OIRD vs control: 42.8% vs 29.6%; OR: 1.7; 95% CI: 1.2 to 2.5; I(2): 0%; p<0.002), pulmonary disease (OIRD vs control: 17.8% vs 10.3%; OR: 2.2; 95% CI: 1.3 to 3.6; I(2): 0%; p<0.001) and obstructive sleep apnoea (OIRD vs control: 17.9% vs 16.5%; OR: 1.4; 95% CI: 1.2 to 1.7; I(2): 31%; p=0.0003). The morphine equivalent daily dose of the postoperative opioids was higher in the OIRD group than in the control; (24.7±14 mg vs 18.9±13.0 mg; mean difference: 2.8; 95% CI: 0.4 to 5.3; I(2): 98%; p=0.02). There was no significant association between OIRD and age, gender, body mass index or American Society of Anesthesiologists physical status. CONCLUSION: Patients with cardiac, respiratory disease and/or obstructive sleep apnoea were at increased risk for OIRD. Patients with postoperative OIRD received higher doses of morphine equivalent daily dose.
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spelling pubmed-63036332019-01-04 Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses Gupta, Kapil Nagappa, Mahesh Prasad, Arun Abrahamyan, Lusine Wong, Jean Weingarten, Toby N Chung, Frances BMJ Open Anaesthesia OBJECTIVE: This systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD). DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed and Clinicaltrials.gov (January 1946 to November 2017). ELIGIBILITY CRITERIA: The inclusion criteria were: (1) adult patients 18 years or older who were administered opioids after surgery and developed postoperative OIRD (OIRD group); (2) all studies which reported both OIRD events and associated risk factors; (3) all studies with reported data for each risk factor on patients with no OIRD (control group) and (4) published articles in English language. DATA ANALYSIS: We used a random effects inverse variance analysis to evaluate the existing evidence of risk factors associated with OIRD. Newcastle-Ottawa scale scoring system was used to assess quality of study. RESULTS: Twelve observational studies were included from 8690 citations. The incidence of postoperative OIRD was 5.0 cases per 1000 anaesthetics administered (95% CI: 4.8 to 5.1; total patients: 841 424; OIRD: 4194). Eighty-five per cent of OIRD occurred within the first 24 hours postoperatively. Increased risk for OIRD was associated with pre-existing cardiac disease (OIRD vs control: 42.8% vs 29.6%; OR: 1.7; 95% CI: 1.2 to 2.5; I(2): 0%; p<0.002), pulmonary disease (OIRD vs control: 17.8% vs 10.3%; OR: 2.2; 95% CI: 1.3 to 3.6; I(2): 0%; p<0.001) and obstructive sleep apnoea (OIRD vs control: 17.9% vs 16.5%; OR: 1.4; 95% CI: 1.2 to 1.7; I(2): 31%; p=0.0003). The morphine equivalent daily dose of the postoperative opioids was higher in the OIRD group than in the control; (24.7±14 mg vs 18.9±13.0 mg; mean difference: 2.8; 95% CI: 0.4 to 5.3; I(2): 98%; p=0.02). There was no significant association between OIRD and age, gender, body mass index or American Society of Anesthesiologists physical status. CONCLUSION: Patients with cardiac, respiratory disease and/or obstructive sleep apnoea were at increased risk for OIRD. Patients with postoperative OIRD received higher doses of morphine equivalent daily dose. BMJ Publishing Group 2018-12-14 /pmc/articles/PMC6303633/ /pubmed/30552274 http://dx.doi.org/10.1136/bmjopen-2018-024086 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Anaesthesia
Gupta, Kapil
Nagappa, Mahesh
Prasad, Arun
Abrahamyan, Lusine
Wong, Jean
Weingarten, Toby N
Chung, Frances
Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses
title Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses
title_full Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses
title_fullStr Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses
title_full_unstemmed Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses
title_short Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses
title_sort risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses
topic Anaesthesia
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303633/
https://www.ncbi.nlm.nih.gov/pubmed/30552274
http://dx.doi.org/10.1136/bmjopen-2018-024086
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