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Post-operative opioid prescription and use in adult cardiac surgery

University of British Columbia

Introduction: Persistent opioid use following cardiac surgery occurs in up to 13% of opioid naïve patients, however, there is little data available to guide analgesic prescription at the time of discharge. The purpose of this research was to examine opioid prescription in adult cardiac surgery through two specific aims: (i) to characterize current discharge opioid prescribing practices in Canada and the United States, and (ii) to characterize patient-level opioid use patterns in the post-discharge period. Methods: Prescription practices in Canada and the United States were examined through a survey of the Canadian Society of Cardiac Surgeons, and a sample of the Centers for Medicare and Medicaid Services dataset, respectively. Patient-level post-discharge opioid use was assessed in a cohort study of patients undergoing sternotomy-based procedures at a tertiary care hospital. Opioid use over the first 10-days after discharge was collected via diary and confirmed with a follow-up researcher-directed pill count. Results: In our survey of Canadian prescribers, 81% reported routinely prescribing opioids at discharge, however, the medication type and dose were highly variable. Furthermore, there was an association between a lack of formal education in opioid prescription and a higher number of pills prescribed (p<0.05). In the United States, there was also wide variation in the dose of opioids prescribed at the provider, state, and regional levels (p<0.001 for all). In total, 116 providers (4.2%) across 32 states prescribed more than two standard deviations above the national mean. Furthermore, on average patients filled only 47% of opioid pills prescribed. Finally, in a prospective cohort study of 104 patients following sternotomy-based procedures, 35% used none and 19.0% used fewer than half of the pills prescribed. Median total consumption was the equivalent of 9 Oxycodone 5mg tablets. Following risk-adjustment, mean pain score >3 on the day of discharge was predictive of opioid use (OR 2.9, 95% CI 1.8-4.8; p<0.001). Conclusion: Opioid prescribing practices after cardiac surgery are highly variable throughout North America. Many patients develop persistent use, possibly contributing to chronic dependence. A large portion of these patients can be managed without opioids at discharge. Our findings may serve as a preliminary benchmark for quality improvement.

Text

2021-01-27

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/77186

Surgery

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/