CC BY-NC-ND 4.0 · AJP Rep 2022; 12(01): e1-e9
DOI: 10.1055/s-0041-1741539
Case Report

Postoperative Respiratory Compromise following Cesarean Birth: The Impact of Obesity and Systemic Opioids

Jessica L. Walker
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, Wisconsin
,
Jacquelyn H. Adams
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, Wisconsin
,
Aimee T. Broman
2   Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
,
Peter G. Pryde
3   Department of Anesthesiology, Madison Anesthesiology Consultants, Madison, Wisconsin
,
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, Wisconsin
› Author Affiliations
Funding This project was supported by the Clinical and Translational Science Award (CTSA) program, through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS), grant no. UL1TR002373 and the University of Wisconsin School of Medicine and Public Health Department of Obstetrics and Gynecology. The funding source had no role in the study design, collection, analysis or interpretation of data, writing of the report, or decision to submit the article for publication.

Abstract

Objective The aim of this study was to measure the effect of obesity and systemic opioids on respiratory events within the first 24 hours following cesarean.

Methods Opioid-naive women undergoing cesarean between January 2016 and December 2017 were included in this retrospective cohort study. The primary outcome was the proportion of women experiencing at least one composite respiratory outcome (oxygen saturation less than 95% lasting 30+ seconds or need for respiratory support) within 24 hours of cesarean. The impact of obesity and total systemic opioid dose in 24 hours (measured in morphine milligram equivalents [MMEs]) on the composite respiratory compromise outcome were evaluated.

Results Of 2,230 cesarean births, 790 women had at least one composite respiratory event. Predictors of the composite respiratory outcome included body mass index (BMI) as a continuous variable (odds ratio = 1.063 for every one unit increase in BMI [95% confidence interval (CI): 1.021–1.108], p = 0.003), and MME (odds ratio = 1.005 [95% CI: 1.002–1.008], p = 0.003), adjusting for magnesium sulfate use. The interaction between obesity and opioid dose demonstrated an odds ratio of 1.000 (95% CI: 0.999–1.000, p = 0.030).

Conclusion The proportion of women experiencing respiratory events following cesarean birth increases with the degree of obesity and opioid dose.

Key Points

  • Respiratory events increase with obesity.

  • Respiratory events increase with systemic opioid use.

  • Odds ratio of respiratory events is 1.063/unit BMI increase.

Paper Presentation Information

Data from this study were presented as a poster presentation at the Wisconsin Association for Perinatal Care, Oshkosh, WI, April 7–9, 2019, abstract number 16.




Publication History

Received: 19 October 2020

Accepted: 08 October 2021

Article published online:
13 January 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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