Retrospective Application of the PRODIGY Risk Prediction Model in Patients Experiencing Postoperative Adverse Respiratory Events



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Background: Postoperative respiratory depression is a major contributor to patient morbidity and mortality. Historically, postoperative opioid-induced respiratory depression (POIRD) has been shown to be difficult to predict, leading to increased patient morbidity and mortality. The Prediction of Opioid-Induced Respiratory Depression in Patients Monitored by Capnography (PRODIGY) model is a novel risk prediction tool. It has been shown to be quick and effective for predicting opioid-induced respiratory depression and utilizes five patient characteristics in its scoring system (age, sex, previous opioid use, sleep disordered breathing, and chronic heart failure).

Purpose: This quality improvement project aimed to determine if the PRODIGY risk prediction model would be a valid predictor of POIRD in the adult, inpatient, postsurgical population at a single, large, academic medical center. Additionally, this project aimed to identify timeframes for naloxone administration as well as surgical specialties where naloxone was used more frequently in the postoperative period.

Methods: This quality improvement project consisted of a retrospective chart review of 47 adult, inpatient, postsurgical patients who had received parenteral opioids and naloxone after anesthesia was concluded. PRODIGY risk scores were determined and then subsequently categorized as low-, intermediate-, or high-risk for developing POIRD. Timeframes for naloxone administration were analyzed and a median time was established. Surgical specialties were grouped and analyzed for increased frequency of naloxone administration.

Results: After application of the PRODIGY risk prediction model, 31 (66%) of patients were categorized as high-risk for developing POIRD. Additionally, 42 (89.4%) of 47 total patients were categorized as intermediate- or high-risk for developing POIRD. Only 5 (10.6%) patients were categorized as low-risk. The median timeframe when naloxone was administered after conclusion of anesthesia was 23.4 hours. The surgical specialties with increased incidence of naloxone administration (>10%) were cardiac surgery (17%), general surgery (14.9%), orthopedic surgery (14.9%), endoscopy (14.9%), vascular surgery (10.6%), and neuro-spine surgery (10.6%).

Conclusion: The PRODIGY risk prediction model was effective in predicting POIRD in adult, inpatient, postsurgical patients who had received parenteral opioids and naloxone following anesthesia at this single, large, academic medical center. This risk prediction tool may be utilized preoperatively to identify high-risk patients, establish opioid-sparing anesthetic techniques, and implement appropriate postoperative monitoring (continuous pulse oximetry and capnography). Confirmation that the median timeframe for naloxone administration was within 24 hours after surgery further supports the use of continuous monitoring in high-risk patients for at least 24 hours after anesthesia is concluded.



PRODIGY, Opioid-induced respiratory depression, Naloxone, Postoperative