Postoperative Respiratory Events in Surgical Patients Exposed to Opioid Analgesic Shortages Compared to Fully Matched Patients Non-exposed to Shortages

Rosa Rodriguez-Monguio (), Zhixin Lun, Tasce Bongiovanni, Catherine L. Chen and Enrique Seoane-Vazquez
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Rosa Rodriguez-Monguio: University of California San Francisco
Zhixin Lun: University of California San Francisco
Tasce Bongiovanni: Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco
Catherine L. Chen: Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco
Enrique Seoane-Vazquez: Chapman University School of Pharmacy

Drug Safety, 2022, vol. 45, issue 4, No 5, 359-367

Abstract: Abstract Introduction Shortages of opioid analgesics critically disrupt clinical practice and are detrimental to patient safety. There is a dearth of studies assessing the safety implications of drug shortages. Objective We aimed to assess perioperative opioid analgesic use and related postoperative hypoxemia (oxygen saturation less than 90%) in surgical patients exposed to prescription opioid shortages compared to propensity score-matched patients non-exposed to opioid shortages. Methods We conducted a retrospective study including adult patients who underwent elective surgery at The University of California San Francisco in the period August 2018–December 2019. We conducted a Gamma log-link generalized linear model to assess the effect of shortages on perioperative use of opioids and a weighted logistic regression to assess the likelihood of experiencing postoperative hypoxemia. Results There were 1119 patients exposed to opioid shortages and 2787 matched non-exposed patients. After full matching, patients exposed to shortages used a greater mean of morphine milligram equivalents/day (146.94; 95% confidence interval 123.96–174.16) than non-exposed patients (117.92; 95% confidence interval 100.48–138.38; p = 0.0001). The estimated effect was a 1.25 (95% confidence interval 1.12–1.40; p = 0.0001) times greater use of opioids in patients exposed to opioid shortages than non-exposed patients. After full matching, a greater proportion of patients exposed to shortages (19.06%) experienced hypoxemia compared with non-exposed patients (16.91%). In addition, a greater proportion of patients exposed to opioid shortages (1.20%) experienced hypoxemia reversed by intravenous naloxone administration compared with non-exposed patients (0.44%). Conclusions Given the shortage prevalence, reliance on opioid medications, and related risk of respiratory depression, harm prevention measures remain critical to prevent postoperative complications that may compromise patients’ safety.

Date: 2022
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DOI: 10.1007/s40264-022-01171-6

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