P-028 - (Poster #28) e-Delphi Consensus Study for Defining, Evaluating, and Managing Postoperative Respiratory Depression (PORD)

Background: Postoperative respiratory depression (PORD) is a serious and potentially life-threatening complication. However, healthcare professionals’ knowledge of the ability to detect, monitor, prevent, and manage PORD in patients has not been well defined using standardized quantitative techniques. The current study used the e-Delphi panel method in order to ascertain the consensus among a group of Board-certified practicing clinician panelists familiar with PORD.

Purpose/Objectives: The primary goal of this study is to employ the e-Delphi panel method to systematically collect expert consensus on the definitions, standard care practices, best approaches, and future directions for managing postoperative respiratory depression (PORD).The study aimed to define and prioritize critical aspects of PORD management, identify areas of agreement and disagreement, and contribute to the development of evidence-based clinical guidelines for managing PORD. It also aimed to explore gaps in clinical knowledge, such creating much-needed Clinical Guidelines on PORD.

Methods: To systematically reach a consensus regarding the definitions, standard of care, best practices, and potential future directions in PORD management, panelists (n=10) (perioperative medicine, pulmonology, anesthesia clinicians) with >5 years of related experience, participated in four rounds of structured online surveys. The e-Delphi iterative feedback method allowed panelist provided structured feedback via ranked agreement on predefined statements (Likert scale; 1–10).  The procedure did not involve subjects or subject data. Statements achieving a score >7 from >70% of panelists over two consecutive rounds were deemed “consensus-reaching” and removed from further iterations. Statements were also ranked for importance during each round. Comments and indications provided by panelists were analyzed to refine statements, inform subsequent rounds, and address any areas of disagreement or ambiguity.

Results: The study successfully defined and prioritized 19 critical statements for PORD management, meeting the primary objective. These findings offer significant insights into the consensus views of perioperative and acute care experts, contributing to the development of best practices and guidelines for managing PORD. The lack of consensus on low-dose naloxone infusions was a surprise, suggesting an unmet clinical need for therapy capable of addressing the limitations associated with existing treatments. Perhaps unsurprising, consensus about the value of intrathecal morphine for reducing PORD required four rounds. This parallels and reflects the extant debate in the literature.

Conclusions/Implications for future research and/or clinical care: This e-Delphi study revealed some important areas of clear consensus for defining, evaluating, and managing PORD. Some other areas did not reach as clear a consensus, or they required more iterative rounds, reflecting, we believe, an accurate assessment of uncertainty in the broader group of healthcare providers. The success of this study suggests that an expanded e-Delphi could result in a consensus leading to much-needed Clinical Guidelines on PORD.