20 Jun Significant Number of Patients Develop Persistent Opioid Use After Cardiac Surgery
MedicalResearch.com Interview with:
Chase Brown, MD
Associate Fellow, Leonard Davis Institute of Health Economics
Integrated Cardiac Surgery Resident
Hospital of the University of Pennsylvania
Nimesh D. Desai, MD, PhD
Director, Thoracic Aortic Surgery Research Program
Associate Professor of Surgery
Hospital of the University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Dr. Chase Brown: Opioid use in the United States is a public health emergency. We know that opioids prescribed after general surgery operations to patients who never received them within the year prior to their surgery are at increased risk for continuing to take opioids months later. However, this has not been studied in patients undergoing cardiac surgery, who often times have more severe post-operative pain.
Our goal in this study was to determine how many patients after cardiac surgery and are opioid naive are continuing to take opioids within 90-180 days after their surgery.
MedicalResearch.com: What are the main findings?
Dr.Chase Brown: We found that among 35,817 patients that filled an opioid prescription within 14 days of a coronary artery bypass grafting (CABG) procedure or heart valve surgery that 9.6% of patients became persistent opioid users by 90-180 days from their operation. Interestingly, we found that patients that underwent a CABG procedure are at a much higher likelihood than patients who undergo a valve surgery for becoming opioid dependent after 90 days. While data from this study does not provide us a reason why, we believe this may be due to the fact that CABG patients have more chest wall trauma from the dissection of the internal mammary artery off the inside of the chest wall that is used during the bypass procedure. This extra dissection is not necessary for a heart valve procedure.
Most interestingly, we found that the more opioids a patient was prescribed at discharge the greater the likelihood that the patient became a persistent opioid user 90-180 days after the operation. In fact, we found that when patients were prescribed more than approximately 300mg of oral morphine equivalents at discharge, or approximately 40 tablets of 5-mg oxycodone, they became increasingly more at risk for opioid dependence long term. We also found that females and younger patients with multiple comorbidites such as congestive heart failure, lung diseases, diabetes, kidney failure, and chronic pain increased the risk for persistent opioid use. Patients taking preoperative benzodiazepines or muscle relaxants were also at highest risk.
MedicalResearch.com: What should readers take away from your report?
Dr. Chase Brown: This study helps us in several ways. It is very important in identifying which patients are at highest risk for opioid dependence. Knowing which patients are at increased risk for becoming persistent opioid users after surgery allows us to provide preoperative education and set realistic pain goals after surgery.
Dr. Nimesh Desai: We demonstrated that 1 out of 10 patients undergoing cardiac surgery will become persistent opioid users after six months from surgery. This is very alarming. We need to not only decrease the amount of opioids provided to patients at discharge but implement evidence-based protocols to initiate a multi-modal analgesic approach for when the patients are in the hospital and after discharge. We believe that many patients after heart surgery can be safely discharged needing minimal opioids.
Brown CR, Chen Z, Khurshan F, Groeneveld PW, Desai ND. Development of Persistent Opioid Use After Cardiac Surgery. JAMA Cardiol. Published online June 17, 2020. doi:10.1001/jamacardio.2020.1445
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