Variability in opioid prescribing practices among cardiac surgeons and trainees

Area of Science:

• Cardiology
• Public Health
• Pain Management

Background:

• The opioid epidemic is a significant public health crisis.
• Discharge opioid prescriptions after cardiac surgery are linked to opioid use disorder.
• Optimal practices for post-cardiac surgery opioid prescribing are not well-defined.

Purpose of the Study:

• To investigate current discharge opioid prescribing practices among cardiac surgeons and trainees.
• To understand the influences on prescribing habits and the need for formal education and guidelines.

Main Methods:

• A survey was developed using a 3-round Delphi method.
• The survey included open- and closed-ended questions on prescription practices (type, dosage, duration).
• Cardiac surgeons and trainees in the Canadian Society of Cardiac Surgeons were surveyed.

Main Results:

• 81% of respondents prescribed opioids at discharge after sternotomy procedures.
• Significant variability was observed in prescribed opioid type and dosage.
• Median prescription was 30 pills (30 (20-30)), totaling 135 Morphine Milligram Equivalents (135 (113-200)).
• Informal teaching was the primary influence; lack of formal education correlated with higher pill counts.
• 91% of respondents saw value in practice guidelines.

Conclusions:

• There is considerable variability in routine opioid discharge prescriptions post-cardiac surgery.
• Education on opioid prescribing is largely informal, highlighting a need for structured learning.
• Establishing standardized guidelines for opioid prescribing after cardiac surgery could aid in addressing the opioid crisis.