Study: 10% of Patients Continue to Use Opioids 3-6 Months after Heart Surgery

Approximately 10% of patients who are prescribed opioid medications after heart surgery continue to use opioids >90 days after the surgery, according to a new study published June 17, 2020 in JAMA Cardiology.

“Our findings support a much-needed shift toward decreasing opioid dosages at discharge and using alternative approaches to reduce the risk for persistent opioid use,” said lead author Chase Brown, MD, MSHP, cardiovascular surgery resident, research fellow, Perelman School of Medicine, University of Pennsylvania, Philadelphia, in a university press release.

Despite recent research that shows persistent opioid use occurs in 3%-10% of patients after minor and major general surgery, there is limited large-scale research that examines this issue among heart surgery patients in the US, the authors said in the study introduction.

Because of this, researchers wanted to determine the proportion of opioid-naïve patients who develop persistent opioid use after heart surgery and to examine the association between the dosage first prescribed and the risk of prolonged use.

Researchers used a national database to collect data of 25 673 patients who underwent coronary artery bypass grafting (CABG) and 10 144 patients who underwent heart valve repair between 2004 and 2016.

Approximately 60% of CABG patients and 53% of valve surgery patients filled an opioid prescription within 14 days of surgery; and 9.6% of the cardiac surgery patients continued to fill prescriptions between 3-6 months post-surgery, with the refill rate slightly higher among CABG patients.

Almost 9% of CABG patients continued to fill prescriptions 180-270 days after surgery. Women, younger patients, and those with preexisting medical conditions (eg, congestive heart failure, chronic lung disease) had a higher incidence rate, researchers also found.

Cardiothoracic surgeons, cardiologists and primary care physicians should work together to enact evidence-based protocols to identify high-risk patients and minimize prescriptions via a multi-faceted pain management approach.

Also, to determine whether the results would apply to “low risk” patients, researchers excluded those who had preoperative use of benzodiazepines and muscle relaxants; had alcoholism, chronic pain, drug use; and those discharged to a facility vs to home after heart surgery. Results showed a similar incidence rate among low-risk patients, with 8% of the patients continuing to use opioids 90-180 days of their discharge.

“Cardiothoracic surgeons, cardiologists and primary care physicians should work together to enact evidence-based protocols to identify high-risk patients and minimize prescriptions via a multi-faceted pain management approach,” said senior author Nimesh Desai, MD, PhD, cardiovascular surgeon, associate professor of surgery, Perelman School of Medicine, University of Pennsylvania, in the same press release. “Centers must adopt protocols to increase patient education and limit opioid prescriptions at discharge.”