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Development of Persistent Opioid Use After Cardiac Surgery

Brown CR, Chen Z, Khurshan F, Groeneveld PW, Desai ND. JAMA Cardiol. doi:10.1001/jamacardio.2020.1445 Published online June 17, 2020.

 

Key Points:

  • 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).
  • Methods:
  • 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
    • Limitations:
  • 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
  • Conclusions:
    • 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

Editorial consultant.