Development of Persistent Opioid Use After Cardiac Surgery.

Area of Science:

• Cardiology
• Pain Management
• Pharmacology

Background:

• Opioid overuse for acute pain management has fueled an epidemic of persistent opioid use.
• Cardiac surgery patients are at risk for developing persistent opioid use.
• Understanding risk factors and prescription patterns is crucial for mitigating this issue.

Purpose of the Study:

• To determine the incidence of persistent opioid use after cardiac surgery in opioid-naive patients.
• To investigate the association between initial opioid prescription amounts at discharge and the likelihood of developing persistent opioid use.

Main Methods:

• Retrospective cohort study utilizing a national administrative claims database (2004-2016).
• Included 35,817 opioid-naive patients undergoing coronary artery bypass grafting (CABG) or heart valve surgery.
• Analyzed new persistent opioid use within 90-180 days post-surgery and the association with discharge oral morphine equivalents (OMEs) using multivariable logistic regression.

Main Results:

• Persistent opioid use occurred in 10.2% of CABG patients and 8.1% of heart valve surgery patients.
• Heart valve surgery was associated with lower odds of persistent use (OR, 0.78).
• Factors increasing risk included female sex, younger age, and specific comorbidities (e.g., chronic pain, diabetes, heart failure).
• Prescribing over approximately 300 OMEs at discharge significantly increased the risk of persistent opioid use.

Conclusions:

• Nearly 1 in 10 patients continue opioid use beyond 90 days post-cardiac surgery.
• Higher initial opioid discharge prescriptions are significantly linked to persistent opioid use.
• Centers should implement protocols for enhanced patient education and judicious opioid prescribing post-discharge.