Association Between Opioid and Benzodiazepine Use and Clinical Deterioration in Ward Patients

Abstract

Background Opioids and benzodiazepines are frequently used in hospitals, but little is known about outcomes among ward patients receiving these medications. Objective To determine the association between opioid and benzodiazepine administration and clinical deterioration. Design Observational cohort study. Setting 500-bed academic urban tertiary-care hospital. Patients All adults hospitalized on the wards from November 2008 to January 2016 were included. Patients who were “comfort care” status, had tracheostomies, sickle-cell disease, and patients at risk for alcohol withdrawal or seizures were excluded. Measurements The primary outcome was the composite of intensive care unit transfer or ward cardiac arrest. Discrete-time survival analysis was used to calculate the odds of this outcome during exposed time periods compared to unexposed time periods with respect to the medications of interest, with adjustment for patient demographics, comorbidities, severity of illness, and pain score. Results In total, 120,518 admissions from 67,097 patients were included, with 67% of admissions involving opioids, and 21% involving benzodiazepines. After adjustment, each equivalent of 15 mg oral morphine was associated with a 1.9% increase in the odds of the primary outcome within six hours (OR 1.019, 95% CI 1.013 – 1.026, p<0.001), and each 1 mg oral lorazepam equivalent was associated with a 29% increase in the odds of the composite outcome within six hours (OR 1.29, 1.16–1.45, p<0.001). Conclusions Among ward patients, opioids were associated with increased risk for clinical deterioration in the six hours after administration. Benzodiazepines were associated with even higher risk. These results have implications for ward monitoring strategies.

The Safety of Benzodiazepines and Opioids in the Geriatric Population: An Analysis of Patient Safety Events Reported by Hospitals and Ambulatory Surgical Facilities

“…9,10 In a study that aimed to determine the association between opioid and benzodiazepine administration and clinical deterioration (defined as a composite of transfer to the ICU or cardiac arrest), researchers found that both medications were associated with an increased risk of clinical deterioration. 11 We did see a clinical deterioration of the patient described in many reports in our study, with patients experiencing a change in mental status or responsiveness, a complete loss of consciousness, a drop in oxygen saturation, respiratory distress, cardiopulmonary arrest, or some combination of these signs and symptoms. About three-fifths of reports in our study involved a patient who received a combination of midazolam and fentanyl, which is often used as part of a general anesthesia regimen.…”

Risk Factors for Severe Opioid-Related Adverse Events in a National Cohort of Medical Hospitalizations

“…Prior analyses have demonstrated increased risk of cardiopulmonary and respiratory arrest in hospitalized patients exposed to opioids. 22,37,38 We are aware of just two prior studies examining risk factors for these outcomes among hospitalized medical patients. 13,22 One was a small, single-center casecontrol analysis that presented only unadjusted associations.…”

Guipi decoction for insomnia

“…Sedative-hypnotics are categorized as high-risk medications, particularly among older adults, and are associated with preventable harm including falls, hip fractures, delirium, and death. [ 20 , 21 ] Observational studies suggest that most indications for sedative-hypnotic initiation in hospitals are potentially inappropriate. [ 22 , 23 ] Therefore, an increasing number of insomnia sufferers are seeking for complementary and alternative therapy for certain advantages like convenient, cheap, and less side effects.…”