INCIDENCE AND OUTCOMES OF LIFE-THREATENING EVENTS DURING HOSPITALIZATION: A RETROSPECTIVE STUDY OF PATIENTS TREATED WITH NALOXONE.

Abstract

BACKGROUND\nWe describe the clinical course of medical and surgical patients who received naloxone on general hospital wards for suspected opioid induced respiratory depression (OIRD).\n\n\nMETHODS\nFrom May 2018 through October 2020, patients who received naloxone on hospital wards were identified and records reviewed for incidence and clinical course.\n\n\nRESULTS\nThere were 86,030 medical and 106,807 surgical admissions. Naloxone was administered to 99 (incidence 11.5 [95%CI 9.4-14.0] per 10,000 admissions) medical and 63 (5.9 [95%CI 4.5-7.5]) surgical patients, P\u2009<\u20090.001. Median oral morphine equivalents administered within 24-hour before naloxone was 32 [15, 64] and 60 [32, 88] mg for medical and surgical patients, respectively, P\u2009=\u20090.002. Rapid response team was activated in 69 (69.7%) vs. 42 (66.7%) and critical care transfers in 51 (51.5%) vs. 30 (47.6%) medical and surgical patients respectively. In-hospital mortality was 21 (21.2%) vs. 2 (3.2%) and discharge to hospice 12 (12.1%) vs. 1 (1.6%), for medical and surgical patients respectively, P\u2009=\u20090.001. Naloxone did not reverse OIRD in 38 (23%) patients, and these patients had more transfers to the intensive care unit and 30-day mortality.\n\n\nCONCLUSION\nMedical inpatients are more likely to suffer OIRD than surgical inpatients despite lower opioid dose. Definitive OIRD was confirmed in 77% of patients because immediate naloxone response, while 23% of patients did not respond and this subset were more likely to need higher level of care and had higher 30-day mortality. Careful monitoring of mental and respiratory variables is necessary when opiates are used in hospital.