Chronic opioid use after coronary bypass surgery

Abstract

Background Opioid dependence has become a major health care issue. Pain management of invasive surgical procedures with opioids may potentially contribute to this epidemic. We sought to determine the association of opioid‐prescribing patterns with chronic opioid use. Methods We retrospectively reviewed all patients undergoing isolated coronary artery bypass graft (CABG) procedures during 2016 at a single institution. Prescribing patterns and medication usage were compared between opioid‐naïve and opioid‐exposed patients (patients with reported opioid use within 30 days prior to surgery). Chronic opioid dependence was defined as opioid usage beyond 90 days after discharge. Results We included 284 opioid‐naïve and 46 opioid‐exposed patients. Although overall prescribing patterns were similar between groups, a higher proportion of opioid‐exposed patients were prescribed a total dose >150 mg of oxycodone per discharge prescription (15.2% vs 4.9%; P = 0.024), and had a higher proportion of refills within 30 days (28.3% vs 10.9%; relative risk [RR] 3.2 [95% confidence interval (CI): 1.5‐6.8]; all P < 0.05). The incidence of chronic opioid dependence was higher among opioid‐exposed patients compared to opioid‐naïve patients (21.7% vs 3.2%; RR 8.5 [95%CI: 3.2‐22.3]; P = 0.001). Conclusions Ongoing opioid use 3 months after CABG is present in 21.7% of opioid‐exposed patients and 3.2% of opioid‐naïve patients. These preliminary findings highlight the burden of prescribing patterns on the overall opioid epidemic and the need to develop alternative pain management strategies.

Chronic post‐operative opioid use after open cardiac surgery: A Danish population‐based cohort study

“…One retrospective study followed 330 patients undergoing isolated coronary artery bypass grafting. Chronic post‐operative opioid use (defined as at least one opioid dispensing beyond 90 days after surgery) was 21.7% for pre‐operative opioid users and 3.2% and for opioid naïve participants (follow‐up time was one year) 27 . Comparison with the present study is hampered by the small study population, short follow‐up, and lack of data on actual opioid dispensing 27 .…”

“…Chronic post‐operative opioid use (defined as at least one opioid dispensing beyond 90 days after surgery) was 21.7% for pre‐operative opioid users and 3.2% and for opioid naïve participants (follow‐up time was one year) 27 . Comparison with the present study is hampered by the small study population, short follow‐up, and lack of data on actual opioid dispensing 27 . Another retrospective study followed opioid naïve Medicare patients undergoing cardiothoracic surgery (coronary artery bypass grafting and/or valve repair/replacement) 6 months after surgery.…”

Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis

“…These stressors may lead to longer hospitalisation and higher use of benzodiazepines and opioids, with their inherent risk of side effects and adverse events. [5][6][7][8][9][10][11][12][13][14] Research efforts have been directed towards approaches to relieve anxiety and pain. Apart from pharmacological therapies, nonpharmacological therapies have provided promising results.…”

Where We Come From and Are We Aware of Where We Are Going To?

“…As a result, the morphine consumption per person has been increasing in the latest years [62] to reach what has been named an opioid epidemic [46,[63][64][65][66][67]. Sometimes the process starts after the prescription of opioids to treat acute pain, for example, after a surgical procedure, but patients get addicted to the drug, and then it becomes difficult to make them abandon their use [68][69][70][71][72]. Opioids are nowadays so widespread that they can be acquired in the illegal market [61,73].…”