New Intermountain Health Study Aims to Prevent Opioid Deaths After Surgery With At-Home Monitoring

Researchers at Intermountain Health are working to prevent one of the severe – even potentially fatal – complications for same-day surgery patients who are given opioids to alleviate their short-term pain by using a simple device that can save lives.

Opioids are a common medication used in surgery. While they can help alleviate pain associated with surgical procedures, they do carry risk of complications even when taken as prescribed, including opioid induced respiratory depression (OIRD), a condition that occurs when an opioid medication suppresses someone’s drive to breathe.

Now, a new study by researchers at Intermountain Health has found that using a simple monitoring device that tracks the oxygen level in someone’s blood can alert caregivers that the patient may not be breathing properly.

Patients who are in the hospital are monitored for signs of opioid induced respiratory depression; however, patients who are treated at same-day/ambulatory surgery centers who often go home less than 24 hours after surgery have not historically been discharged with monitors. They are often looked after by a loved one who may not recognize when respiratory distress is occurring.

In the new study published in The Respiratory Care Journal, researchers from Intermountain Health found that discharging high-risk patients with opioids from same day surgery centers with this simple monitoring device can be lifesaving. The monitoring device alerts caregivers of opioid induced respiratory depression, which leads to proper emergency medical care.

In fact, for one patient enrolled in the study, a family member receiving the respiratory depression alert was able to administer the opioid-reversing drug naloxone in time to save the patient’s life.

“We’re often sending patients home with untrained caregivers who might not know what to do or what signs to look for that could indicate opioid induced respiratory depression,” said Robert Mazzola, MD, principal investigator of the study and enterprise senior medical director for sleep services at Intermountain Health. “We found that with a simple, commercially available pulse oximeter and monitoring device, we can save lives.”

The study included patients who were undergoing same-day orthopedic surgery at the Intermountain Orthopedic Specialty Hospital between September 2019 and October 2020 who were also at high risk for developing opioid induced respiratory depression.

Risk factors included patients who had signs of undiagnosed sleep apnea (like snoring, tiredness, high blood pressure, high body mass index), or had confirmed sleep apnea but were non-compliant with wearing a continuous positive airway pressure (CPAP) machine to help them breathe while asleep.

Those patients were sent home with a monitoring device that measures how much carbon dioxide a patient breathes out and oxygen saturation levels.

Patients were then monitored at home for four days while napping and sleeping by home caregivers, often friends or family members of the patient, who received training at the hospital on what to do if an alarm sounded. Those caregivers were also given naloxone, an overdose reversing medication, and instructed on how and when to use it.

Of the 359 patients for whom data was recorded, 26 patients required emergency room treatment due to a low oxygen saturation level alarm from the monitor.

Of those patients, 14 experienced opioid related respiratory depression and/or opioid related events, and one was given naloxone which most likely saved their life.

A second patient was diagnosed with an opioid induced heart attack in the emergency room after the home caregiver responded to the monitor’s alarm. A third was diagnosed with opioid induced renal failure, requiring dialysis and a stay in the ICU.

Three patients experienced surgery-related complications, such as pulmonary embolism.  The patients went to the emergency room as directed. Though not opioid-related, patients and their caregiver sought care due to low oxygen saturation level alarms.

“Death due to opioid induced respiratory depression should not be the only concern for high-risk opioid patients prescribed opioids for pain. Hypoxic organ damage can also occur and can be identified earlier resulting in more timely intervention. We were able to identify those patients diagnosed in the emergency room with opioid related events and/or opioid induced respiratory depression,” said Kim Bennion, MsHS, study co-author and research director of respiratory care clinical services at Intermountain Health.

“Through a simple pulse oximeter you can wear on your finger, we were able to effectively monitor for that and have patient’s and/or their home caregiver take action,” added Bennion.

Additionally, researchers found that patients who had an incident that required them to go to the emergency department were having them at about 1.8 days post-surgery – longer than the 24-hour period typically associated as the riskiest time for opioid induced respiratory depression.

As promising as using a pulse oximeter was, the study also showed that measuring carbon dioxide levels with a nasal cannula is challenging in the home environment.

Researchers found the device could potentially set off false alarms after about 12 hours due to moisture wicking problems. While successful in the in-hospital setting, the home was an uncontrolled environment which may have resulted in the erroneous alarms.

“Our study demonstrates the importance of using technology in the home to monitor these patients and help the person watching them, whether a loved one or a friend, to make them safer,” said Dr. Mazzola

Bennion, who has lost two family members to opioid induced respiratory depression, has worked with state lawmakers on a resolution urging state legislators, hospitals, physicians, and medical researchers to raise awareness of the risks of taking opioids even as prescribed – and the need for monitoring at home to identify opioid induced respiratory depression.

The Utah resolution also encourages doctors to discharge post-operative surgery patients with a pulse oximeter when opioids are prescribed.

The study was funded by the Intermountain Research Foundation with naloxone provided by Intermountain Health Pharmacy Clinical Services.

About Intermountain Health

Headquartered in Utah with locations in six states and additional operations across the western U.S., Intermountain Health is a not-for-profit system of 34 hospitals, approximately 400 clinics, medical groups with some 4,600 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For up-to-date information and announcements, please see the Intermountain Health newsroom at https://intermountainhealthcare.org/news.