Pulse oximetry monitoring at home found to save lives of high-risk opioid surgery patients

Editor's Note

Intermountain Health researchers have uncovered a practical solution for reducing the risk of opioid-induced respiratory depression (OIRD) in same-day surgery patients, showing that a basic monitoring device—specifically, a pulse oximeter—can save lives, News Channel Nebraska March 27 reports. The study, published in the Respiratory Care Journal, focused on patients with short-term opioid prescriptions who are typically discharged within 24 hours but remain at risk of serious complications at home.

Hospitalized patients receive ongoing monitoring to guard against dangerous drops in oxygen levels caused by opioid suppressed breathing, but those sent home from ambulatory surgery centers may need to rely on friends or family who are not trained to recognize the early signs of respiratory distress. This research shows that a pulse oximeter can provide early warning and prompt caregivers to intervene quickly if oxygen levels fall.

The Intermountain Health team reviewed outcomes for 359 high-risk orthopedic surgery patients discharged with opioids between September 2019 and October 2020. Each patient had either undiagnosed sleep apnea symptoms or was known to be noncompliant with a CPAP device. These individuals received a pulse oximeter and a nasal cannula that measured carbon dioxide levels. Caregivers were trained to respond to alarms and provided with naloxone.

Over 4 days of at-home monitoring:

• 26 patients required emergency care after a low oxygen alarm
• 14 of the above 26 had opioid-related respiratory issues
• 1 needed naloxone to survive
• others experienced severe events like opioid-induced heart attack or renal failure.

Notably, incidents requiring emergency intervention typically happened around 1.8 days post-surgery—beyond the highest-risk period of the first 24 hours. The study also revealed challenges in accurately measuring carbon dioxide in a home setting due to moisture and environment factors, highlighting the pulse oximeter as the more reliable component.