Opioid Overdose in the Hospital Setting: A Systematic Review

Abstract

Objective: Our objective was to determine the percentage of opioid overdose events among medical and surgical inpatient admissions, and to identify risk factors associated with these events. Methods: We searched PubMed and CINAHL databases from inception through July 30, 2017 and identified additional studies from reference lists and other reviews. Articles were included if they reported original research on the rate of opioid overdoses or opioid-related adverse events, and the adverse events occurred in a general medical hospital during an inpatient stay. We extracted information on study population, design, results, and risk for bias using the Newcastle-Ottawa Quality Assessment Scale. We performed this review in accordance with recently suggested standards and report our findings as per the Meta-Analyses and Systematic Reviews of Observational Studies guidelines. Results: Thirteen studies met our eligibility criteria. The percentage of opioid overdoses ranged from 0.06% to 2.50% of hospitalizations. The majority of studies used only 1 method of event detection. Risk factors for overdose included older age, infancy, medical comorbidity, substance use disorder diagnosis, combining opioids with other sedatives, and admission to hospitals with higher opioid-prescribing rates. Conclusions: Opioid overdose in the inpatient setting is a serious preventable harm and is likely underestimated in much of the current literature. Improved detection methods are needed to more accurately measure the rate of inpatient opioid overdose. Refined estimates of opioid overdose should be used to drive safety and quality improvement initiatives in hospitals.

A Large-Scale Observational Study on the Temporal Trends and Risk Factors of Opioid Overdose: Real-World Evidence for Better Opioids

“…In this study, we found that opioid overdose increased significantly at the US inpatient care setting from 2009 to 2017. As pointed out by Danovitch et al [ 52 ], inpatient opioid overdose is a serious harm, yet preventable, and is likely to be underestimated in much of the current literature. The significant increasing trends observed in Health Facts ® , a large-scale EHR database, suggested that prevention and control measures for opioid overdose had been inadequate at the US inpatient setting over these years, especially for patient subgroups with prominent increasing trends, such as patients from the South and patients in a rural area.…”

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

“…One risk factor for opioid overdose in the hospital setting that has been identified in several studies is the concomitant use of sedating medications, including benzodiazepines. 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.…”

A Large-Scale Observational Study on the Temporal Trends and Risk Factors of Opioid Overdose: Real-World Evidence for Better Opioids

“…In this study, we found that opioid overdose increased significantly at the US inpatient care setting from 2009 to 2017. As pointed out by Danovitch et al, inpatient opioid overdose is a serious harm, yet preventable, and is likely to be underestimated in much of current literature 45 . The significant increasing trends observed from Health Facts ® , a large-scale EHRs database, indicated that prevention and control measures for opioid overdose had been inadequate at the US inpatient setting over these years, especially for patient subgroups with prominent fold increases, such as patients from South and patients in rural area.…”