Brown CR, Chen Z, Khurshan F, Groeneveld PW, Desai ND. JAMA Cardiol. doi:10.1001/jamacardio.2020.1445 Published online June 17, 2020.
- Background: Opioids prescribing for pain management have contributed to long term issues related to opioid use.
- Objective: To assess the frequency and discharge dose factors following cardiac surgery of persistent opioid use in prior opioid nonusers (No opioid RX within 180 days of Cardiac Surgery).
- Retrospective cohort study using a national administrative claims data base 1/1/2004 to 12/31/2016
- Results: (90-180 days post-surgery)
- Eligible Heart Surgery Patients – 35,817
- Coronary Bypass Surgery (CABG) – 25,673 (71.7%)
- Valve Surgery – 10,144 (28.3%)
- Post Heart Surgery opioid users:
- CABG – 2609 (10.2).
- Valve surgery – 821 (8.1%). (CABG vs. Valve surgery, P<0.001)
- Risk factors for persistent opioid use:
- Demographics – CABG surgery, Women, Younger patients
- Pre-surgery Factors – CHF, Chronic Lung disease, Diabetes, Kidney Failure, Chronic Pain, and Alcoholism, pre op use of benzodiazepines and muscle relaxers.
- Opioid Dosing: Discharge Rx > 300 mg Oral Morphine Equivalents
- The database is private insure of managed Medicare and may not be representative of all populations.
- Such databases are subject to coding errors and do not represent other sources of narcotics
- Approximately 1 in 10 patients post cardiac surgery continue to use opioids > 90 days post-surgery.
- Higher opioid discharge doses were associated with greater late use.
- Editorial Comment:
- Screening patient’s pre-op for opioid risk is important and in patients with both percutaneous as well as surgical revascularization options, opioid use risk may be a useful not usually discussed factor in decision-making.
George W. Vetrovec, MD, MACC, MSCAI