Home Monitoring of High-Risk Individuals Receiving Opioids Post Orthopedic Surgery.
Background: Postoperative patients receiving opioids are at risk for morbidity and mortality caused by opioid-induced respiratory depression (OIRD). Guidelines advocate electronic monitoring for OIRD during postoperative hospitalization, but the utility of home monitoring following ambulatory surger...
| Publicado en: | Respiratory Care Vol. 70; no. 8; pp. 968 - 979 |
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| Autores principales: | , , , , , , , , , , , , , , |
| Formato: | CEU research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Aug2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187150232&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187150232 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Aug2025 vid: 70 iid: 8 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 187150232 187150232 187150232 10.1089/respcare.11783 187150232 ppf: 968 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Home Monitoring of High-Risk Individuals Receiving Opioids Post Orthopedic Surgery. aug: au: Mazzola, Robert L. Bennion, Kim J. Hepworth, Megan J. Petersen, Greg G. Breeze, Gaylinn Jensen, Kelly C. Jensen, Megan Henriksen, Vanessa Bagley, Lisa Keddington, Chance Snow, Gregory L. Belnap, Tom Winberg, Carrie M. Papenfuss, Shawna B. Cloward, Tom V. affil: Drs. Mazzola and Cloward are affiliated with Department of Sleep Medicine, Intermountain Health Care Inc, Murray, Utah, USA. sug: subj: Orthopedic Surgery Analgesics, Opioid Adverse Effects Respiratory Failure Chemically Induced Patient Discharge Patient Attitudes Monitoring, Physiologic Home Environment Respiratory Failure Diagnosis Education, Continuing (Credit) Human Prospective Studies Nonexperimental Studies Capnography Pulse Oximetry Quality Improvement Postoperative Complications Data Analysis Software Fisher's Exact Test Young Adult Adult Middle Age Aged Funding Source Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years ab: Background: Postoperative patients receiving opioids are at risk for morbidity and mortality caused by opioid-induced respiratory depression (OIRD). Guidelines advocate electronic monitoring for OIRD during postoperative hospitalization, but the utility of home monitoring following ambulatory surgery has not been assessed. We describe the utilization of capnography and pulse oximetry in an ambulatory orthopedic cohort to determine subject/home caregiver acceptance and utility of continuous monitors at home. The specific aims of this initiative were to (1) determine the subject/home caregiver acceptance of home monitoring to detect OIRD in patients after hospital discharge following orthopedic surgery, (2) determine the rate of OIRD and associated morbidity after hospital discharge following orthopedic surgery, and (3) determine patient understanding of the risk of OIRD. Methods: This prospective, subject/home caregiver acceptance quality improvement initiative was conducted from September 28, 2019, to October 31, 2020. Ambulatory subjects undergoing orthopedic surgical procedures had cardiorespiratory data monitored with a commercially available device at home for 4 days while napping/sleeping. Recorded data were analyzed for reliability comparing end-tidal carbon dioxide pressure (PETCO2), SpO2, breathing frequency (f), and heart rate (beats/min). Results: Three hundred fifty-nine subjects were enrolled and had complete data. Two hundred fifty-two (70%) were discharged with supplemental oxygen. When comparing audible alarms with/without delays, there were 4,770/22,409 low PETCO2, 1,601/6,246 high PETCO2, 460/4,211 low frequency, 1,572/6,547 low heart rate, and 462/5,520 low SpO2 alarms. Twenty-six (7.2%) subjects visited the emergency department in response to low SpO2 audible alarms. Of these, 14 (3.9%) were diagnosed with a clinically relevant opioid-induced event, 95% CI 2.1%–6.5%, and 1 subject was administered naloxone by home caregivers. Conclusions: This study demonstrates home monitoring of oxygenation (SpO2), but not respiration (PETCO2), following ambulatory orthopedic procedures is feasible. Subjects at risk for clinically relevant opioid events may experience higher rates of postoperative complications, hospital readmissions, clinically relevant events, or death. pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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