PRODIGY score predicts respiratory depression in the post-anesthesia care unit: A post-hoc analysis

Abstract

Surgical patients who experience respiratory depressive episodes (RDEs) during their post-anesthesia care unit (PACU) admission are at a higher risk of developing subsequent respiratory complications in general care wards. A risk assessment tool for PACU RDEs has not been previously assessed. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) score is an assessment tool that uses baseline patient variables to categorize patients into low-, intermediate-, or high-risk groups for RDEs in general care wards. This study assessed whether PRODIGY groups are associated with PACU RDEs. This analysis utilized data from a previous observational trial of PACU RDEs detected by capnography. PRODIGY scores were retrospectively calculated, and the number and duration of respiratory alerts were compared among PRODIGY groups. Twenty-six (29.9%) patients were classified as low risk, 29 (33.3%) as intermediate risk, and 32 (36.8%) as high risk. A total of 3580 alerts were recorded in the PACU, 47% of which were apnea episodes lasting ≥ 10 s. The total number and duration of alerts were highest in high-risk group patients (median 56 [IQR 12–87] alerts per patient vs 22 [9–37] in low-risk and 26 [13–42] in intermediate-risk patients, P = 0.035; 303 [123–885] s vs 177 [30–779] in low-risk and 301 [168–703] in intermediate-risk patients, P = 0.042).Poisson regression analysis indicated thatthe rate of RDEs in the high PRODIGY risk group was higher than in the intermediate (rate ratio estimate = 2.01 [95% CI 1.86–2.18], P < 0.001) and low (rate ratio estimate = 2.25 [95% CI 2.07–2.45], P < 0.001) risk groups. This analysis suggests that the PRODIGY score may be useful in assessing the risk of PACU RDEs. Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT02707003.