Study Details Costs of Opioid-Induced Respiratory Depression in Hospitals

People who are given opioids in the hospital for pain relief sometimes develop respiratory depression, a condition that occurs when the lungs fail to properly exchange oxygen and carbon dioxide, causing a buildup of carbon dioxide that can lead to a host of other health problems, from rapid heart rate to seizures; untreated, the condition can cause respiratory arrest, brain damage or even death.

Previously, the PRODIGY study found that opioid-induced respiratory depression is a problem in medical and surgical wards, and that patient monitoring is needed to prevent these cases when patients receive opioids after surgery—however, using tramadol or epidural opioids may reduce the risk.

Now, a new evaluation of the PRODIGY data has quantified just how costly the phenomenon can be in the United States. Published in BMC Anesthesiology and led by Ashish K. Khanna, MD, of Wake Forest School of Medicine, the study examined cost data collected from 420 of the 769 U.S. patients enrolled in the original study. The research team looked at the differences in the amount of health care use and costs for patients with and without at least one respiratory depression episode.

Patients who had at least one respiratory episode during their hospitalization ended up with longer stays—6.4 days on average for those with an episode, compared with 5.0 days for those without one. Costs were higher for those with an episode, too; $21,892 on average, compared with $18,206 on average.

In the earlier study, researchers had used a risk prediction tool to evaluate which patients were most likely to have respiratory depression during their stay. Those at high risk, as predicted by the tool and had at least one episode had higher costs compared with high risk patients without respiratory depression: $21,948 vs. $18,474.

The longer a patient stayed in the hospital, the more the stay drove up costs, “with the cost increasing exponentially” for patients with at least one respiratory depression episode as length of stay increased.

The study drilled down on individual factors that contributed to length of stay and, in turn, higher cost. “Use of multiple opioids; longer, high risk, or open surgery; respiratory depression; and medical conditions including chronic heart failure, hypertension, and sepsis, all contributed to increased length of stay,” the authors wrote.

The calculation method used in the study accounted for heart failure and a patient’s history of opioid use, and found that that both respiratory depression and length of stay continued to cost. Authors suggested their findings would be of use to payers and would point to areas where hospitals needed to implement quality metrics to reduce costs. Notably, the analysis excluded extremely high cost outlier patients; thus, the study reflects the differences “between typical general care floor patients with and without respiratory depression.”