Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden.

Opioid-induced respiratory depression (OIRD) and postoperative nausea and vomiting (PONV) are challenging, resource-intensive, and costly opioid-related adverse events (ORAEs). Utilizing the Premier Healthcare Database, we identified patients > 18 years old, who underwent at least one surgical procedure of interest (i.e., cardiothoracic/vascular, general/colorectal, obstetric/gynecologic, orthopedic, or urologic), and received at least one dose of intravenous morphine, hydromorphone, or fentanyl for acute postoperative pain. The incidence of OIRD and PONV using ICD-9 codes, factors influencing these AEs, length of stay (LOS) and related costs were analyzed. Among 592,127 inpatient stays, rates of respiratory depression ranged from 3% (obstetric/gynecologic) to 17% (cardiothoracic/vascular) and nausea/vomiting from 44% (obstetric/gynecologic) to 72% (general/colorectal). Increased odds of OIRD were associated with older age (cardiothoracic/vascular, general/colorectal, obstetric/gynecologic); obesity, respiratory conditions, and sleep apnea (all surgery groups); opioid dose (cardiothoracic/vascular, general/colorectal, orthopedic); and sedative use after day 1. Increased odds of PONV were associated with younger age, female sex, and major disease severity. When respiratory depression or nausea/vomiting was present versus absent, LOS was significantly longer, and hospital costs were higher. In this analysis, OIRD and PONV were more prevalent than previously reported, were associated with identifiable risk factors, and had substantial effects on resource utilization and costs.

The effectiveness of a multicenter quality improvement collaborative in reducing inpatient mortality.

MOTIVATION AND BACKGROUND: This study examines the evidence that a particular quality improvement collaborative that focused on Quality, Efficiency, Safety and Transparency (QUEST) was able to improve hospital performance. SETTING: The collaborative included a range of improvement vehicles, such as sharing customized comparative reports, conducting online best practices forums, using 90-day rapid-cycle initiatives to test specific interventions, and conducting face-to-face meetings and quarterly one-on-one coaching sessions to elucidate opportunities. METHODS: With these kinds of activities in mind, the objective was to test for the presence of an overall "QUEST effect" via statistical analysis of mortality results that spanned 6 years (2006-2011) for more than 600 acute care hospitals from the Premier alliance. RESULTS: The existence of a QUEST effect was confirmed from complementary approaches that include comparison of matched samples (collaborative participants against controls) and multivariate analysis. CONCLUSION: The study concludes with a discussion of those methods that were plausible reasons for the successes.