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The following is a summary of “Risk Stratification for Postoperative Opioid Induced Respiratory Depression: A Retrospective Case-Control Analysis of Existing Validated Tools” published in the April 2025 issue of Journal of Pain Research by Hutcheson et al.
Researchers conducted a retrospective study to evaluate whether three pre-existing validated opioid risk tools and specific risk factors could assess postoperative opioid-induced respiratory depression (POIRD) risk in patients discharged from the Post-Anesthesia Care Unit (PACU).
They included 126 matched patients who underwent surgery at the University of Tennessee Medical Center from January 2019 to December 2021. Patients with active traumas or burns were excluded from the study. The primary endpoint was escalation of care due to respiratory failure (an increase in respiratory support with transfer to an intensive care unit/stepdown unit or patient expiration due to respiratory failure), with a subgroup receiving naloxone as the surrogate POIRD endpoint. Escalation of care due to respiratory failure, regardless of naloxone use, was considered a secondary endpoint.
The results showed no association between the 3 opioid tools evaluated and the POIRD surrogate endpoint or escalation of care. Bipolar disorder (OR 3.68; 95% CI 1.11–9.56) and a history of substance abuse (OR 26.33; 95% CI 5.18–119.02) were significant risk factors for escalation of care due to respiratory failure. A history of substance abuse was also significantly associated with escalation of care due to respiratory failure with naloxone administration (OR 6.886; 95% CI 2.02–23.56).
Investigators concluded that, although no tool was identified to stratify POIRD risk, patients with bipolar disorder and a history of substance abuse faced an increased risk of postoperative respiratory failure, with substance abuse linked to POIRD.
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