P-046 - Assessing the Market Need for Advanced Postoperative Respiratory Depression Treatment

Abstract Title: Assessing the Market Need for Advanced Postoperative Respiratory Depression Treatment

Background: The ever-increasing number of surgical procedures across the United States, compounded by an aging demographic, presents a concerning potential for increased instances of postoperative respiratory depression (PORD). PORD can arise from a number and combination of variables leading to reduced pulmonary function including prolonged supine positioning¹, anesthetics and analgesics utilized during surgery, use of narcotics for analgesic management, and can be exacerbated by certain types of surgeries including thoracic or abdominal procedures that further diminish lung capacity². The majority of PORD events (85%) occur within the initial 24 hours post-surgery.³ Atelectasis occurring at the induction of anesthesia, and possibly persisting post-surgery¹, can lead to varying degrees of respiration depression. These effects may have clinically relevant long-term consequences including heightened morbidity and mortality beyond the time of hospital discharge.⁴

Purpose/Objectives: Understanding the critical importance of this issue, the primary objective of this qualitative market research endeavor was to thoroughly assess the current landscape of PORD treatment. Additionally, it aimed to identify specific areas where improvements are needed, ensuring more effective and efficient management and care for patients affected by this condition.


Methods: To achieve this objective, qualitative interviews were conducted with twenty diverse healthcare professionals, including surgeons, nurses, and anesthesiologists. Their participation was based upon the following criteria:

Surgeons and Anesthesiologists: Participated in >10 (anesthesiologist) and >20 (surgeon) surgeries per month over the past year; >10 PORD patients in the past year; must have >1 peer-reviewed publications and/or book contributions on PORD in last 3 years (anesthesiologist); sample included academic and community as well as in-patient and outpatient settings of care; sample included multiple surgery types associated with PORD, such as emergency, head and neck, and thoracic surgery.

Nurses: Split between inpatient and outpatient surgical settings as well as academic and community settings of care; helped manage ≥10 PORD patients in the past year; must work in PACU, ICU, or recovery room setting and specialties where PORD may be prevalent (critical care, surgical, etc.)


Results: The insights gleaned from these interviews shed light on several critical aspects of PORD management. Surgeons and nurses uniformly regarded PORD as a severe surgical complication, often linked with unfavorable patient outcomes. Conversely, anesthesiologists, while acknowledging the existence of PORD, tended to prioritize other concerns given the perceived adequacy of existing control measures. However, all healthcare providers (HCPs) acknowledged the downstream ramifications of PORD, although there was a consensus on the challenge posed by the variability in its definition and incidence rates.

Of significant concern was the management of PORD beyond the immediate post-anesthesia care unit (PACU) setting, particularly in community hospitals where monitoring resources may be limited. Respondents highlighted the potential for undetected PORD symptoms in such environments, leading to exacerbated cases and adverse patient outcomes. Despite available reversal agents and risk mitigation techniques, there emerged a consensus among HCPs for the need of a prophylactic agent capable of preemptively addressing PORD risk without necessitating significant adjustments to surgical protocols, such as anesthesia or opioid usage reductions. This need was particularly emphasized for high-risk patient populations, such as those with chronic obstructive pulmonary disease (COPD) or undergoing high-risk surgeries.

Moreover, the economic burden associated with PORD was underscored, with prolonged ICU or general ward stays incurring substantial costs ranging from $4,000 to $15,000 per additional day.

Conclusions/Implications for future research and/or clinical care: In summary, the findings of this market research underscore the imperative for establishing a consensus definition of PORD, augmenting awareness among healthcare professionals, and advocating for comprehensive education on the significant economic and healthcare burdens associated with this condition. These insights provide a robust foundation for future initiatives aimed at advancing PORD management strategies and improving patient outcomes.

References: 1. McPherson K, Stephens R. Postoperative respiratory complications. Br J Hosp Med (London). 2016;77(4):C60-64

2. Golder FJ, Hewitt MM, McLeod JF. Respiratory stimulant drugs in the post-operative setting. Respir Physiol Neurobiol. 2013;189(2):395-402

3. Weingarten TN, Wagner LL, Sprung J. Timing of postoperative respiratory emergencies: when do they really occur? Curr Opin Anaesthesiol. 2017;30(1):156-162

4. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317-334