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

Abstract

Background Knowledge of chronic opioid use after cardiac surgery is sparse. We therefore aimed to describe the proportion of new chronic post‐operative opioid use after open cardiac surgery. Methods We used prospectively registered data from a national prescription registry and a clinical registry of 29 815 first‐time cardiac surgeries from three Danish university hospitals. Data collection spanned from 2003 to 2016. The main outcome was chronic post‐operative opioid use, defined as at least one opioid dispensing in the fourth post‐operative quarter. Data were assessed for patient‐level predictors of chronic post‐operative opioid use, including pre‐operative opioid use, opioid use at discharge, comorbidities, and procedural related variables. Results The overall proportion of post‐operative opioid use was 10.6% (95% CI: 10.2‐10.9). The proportion of new chronic post‐operative opioid use was 5.7% (95% CI: 5.5‐6.0) among pre‐operative opioid naïve patients. The corresponding proportions among patients, who pre‐operatively used low or high dose opioid (1‐500 mg or > 500 mg cumulative morphine equivalent opioid), were 68.3% (95% CI: 66.1‐70.4) and 76.3% (95% CI: 74.0‐78.5) respectively. Risk factors associated with new chronic post‐operative opioid use included: female gender, underweight and obesity, pre‐operative comorbidities, acute surgery, ICU‐time > 1 day, and post‐operative complications. Strongest predictor of chronic post‐operative opioid use was post‐discharge use of opioid within one month after surgery (odds ratio 3.3, 95% CI: 2.8‐4.0). Conclusion New chronic post‐operative opioid use after open cardiac surgery is common. Focus on post‐discharge opioid use may help clinicians to reduce rates of new chronic opioid users.

Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain

“…Nearly all types of surgery that yield high postoperative pain can be treated with IV-PCA in the acute phase; examples of such surgeries include spine and other complex orthopedic surgeries, such as knee and hip [15], open abdominal [16] and non-ambulatory laparoscopic surgery [17]; and thoracic [18], major cervicofacial and reconstruction surgeries [19], including breast surgeries [20]. In addition to initial severe postoperative pain, some surgeries can also yield chronic postoperative pain such as cardiac [21], knee [22] shoulder [23] and hip pain [24]. Therefore, special attention should be paid to these surgeries to propose the most efficient technique for patients, which might not be IV-PCA in some circumstances (Table 1).…”

The complications of opioid use during and post–intensive care admission: A narrative review

“…The incidence of chronic post-ICU opioid use ranges from 2.6% to 16.3% in patients who were opioid-naive prior to ICU admission. 1,34,70 –72,74 –79 Trials with a larger incidence of persistent opioid use used a definition of single prescriptions of opioids. Using a time-based prescription of 120 days of opioid supply within the first year after ICU hospitalisation, Wunsch et al.…”

“…Several studies of varying ICU cohorts have analysed the incidence and potential causative factors associated with persistent opioid use after the ICU. 1,34,[69][70][71][72][73][74][75][76][77][78][79] Overall, the incidence of persistent opioid use after the ICU ranges from 2.6% to 70%. This observed variability is due to the inclusion of patients with preexisting opioid use, variable time to follow-up, differing definitions of chronic opioid therapy and the patient cohort being studied.…”

“…The incidence of chronic post-ICU opioid use ranges from 2.6% to 16.3% in patients who were opioid-naive prior to ICU admission. 1,34,[70][71][72][74][75][76][77][78][79] Trials with a larger incidence of persistent opioid use used a definition of single prescriptions of opioids. Using a timebased prescription of 120 days of opioid supply within the first year after ICU hospitalisation, Wunsch et al reported the incidence of chronic opioid therapy in ICU patients receiving mechanical ventilation to be 2.6%, 1 with prescriptions occurring more in surgical patients than medical patients (4.1% versus 1.6% at 12 months).…”

Commentary: The dose makes the poison: A look at opioid-free analgesia

“…In 1 study, the rate of chronic opioid use in opioid naïve patients after cardiac surgery was 5.7%. 9 Grant and colleagues 1 make the excellent point that posthospital management is crucial and care must be paid to opioid prescribing at the time of discharge. A recent review shows existing data do not support opioid-free being exceptional to opioid-sparing approaches.…”