Opioid-induced respiratory depression or oversedation risk assessment in hospitalized patients with cancer receiving palliative care

PurposeThe Oversedation Risk Criteria (ORC) is a prediction model that estimates prescription opioid-induced respiratory depression (OIRD) or oversedation risk in hospitalized patients. The study objectives were to estimate OIRD/oversedation risk via the ORC and to determine the frequency of an OIRD/oversedation event in hospitalized patients with cancer who received palliative care.MethodsThis single-center, retrospective analysis included patients who were at least 18 years of age, diagnosed with cancer, currently taking an opioid, and completed an initial palliative care consultation from January 1, 2022 to July 31, 2023. Manual data collection and International Classification of Disease, 10th revision (ICD-10) codes were utilized to confirm ORC predictive factors. The ORC predictive factors were summed and patients were risk stratified. An OIRD/oversedation event was defined as successful reversal by naloxone.ResultsThe ORC score (mean ± SD) was 10.6 ± 4.9, which correlated with moderate risk (n = 649). The number of patients at low, moderate, and high-risk for an OIRD/oversedation event was 282 (43%), 356 (55%), and 11 (2%), respectively. Five patients (0.8%) experienced an OIRD/oversedation event that was reversed by naloxone. Concurrent sedation medication use was 80% (n = 517). One-hundred and sixty (25%) and 131 (20%) patients were on a benzodiazepine and a gabapentinoid.ConclusionsPatients with cancer on an opioid who received palliative care are at moderate OIRD/oversedation risk during their hospitalization.