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Heart Surgery Leads to Long-Term Opioid Use for Some

MONDAY, June 22, 2020 (HealthDay News) — About one in 10 heart surgery patients who is prescribed an opioid painkiller after the procedure still uses the drugs more than 90 days later, a new study finds.

And those prescribed the highest doses are most likely to be long-term users of opioids, researchers say.

“Our findings support a much-needed shift toward decreasing opioid dosages at discharge and using alternative approaches to reduce the risk for persistent opioid use,” study lead author Dr. Chase Brown said in a University of Pennsylvania news release. He’s a cardiovascular surgery resident and research fellow at the university’s Perelman School of Medicine.

Overprescribing of opioids — including oxycodone, codeine, tramadol and morphine — can increase the risk of opioid addiction. Recent research suggests that opioid overprescribing is common in the United States.

It’s believed that persistent opioid use occurs in 3% to 10% of patients after minor and major general surgery, but there is limited large-scale research on the issue among U.S. heart surgery patients.

In this new study, researchers examined data on over 25,000 U.S. patients who had coronary artery bypass grafting (the most common type of heart surgery) and over 10,000 who had heart valve repair or replacement between 2004 and 2016.

About 60% of bypass patients and 53% of valve surgery patients filled an opioid prescription within 14 days after surgery.

The study also found that 9.6% of all the patients continued to fill prescriptions between three and six months after surgery, with the refill rate slightly higher among bypass patients. Nearly 9% of bypass patients continued to fill an opioid prescription six to nine months after surgery.

Rates of long-term opioid use were highest among women, younger patients and those who had medical conditions before surgery, such as heart failure, chronic lung disease, diabetes and kidney failure, the findings showed.

The researchers also found that patients who were prescribed higher doses of opioids had a significantly increased risk of continued opioid use three to six months after surgery.

“Cardiothoracic surgeons, cardiologists and primary care physicians should work together to enact evidence-based protocols to identify high-risk patients and minimize prescriptions via a multi-faceted pain management approach,” said study senior author Dr. Nimesh Desai, a cardiovascular surgeon and an associate professor of surgery at the university.

“Centers must adopt protocols to increase patient education and limit opioid prescriptions at discharge,” Desai concluded.

The study was published online June 17 in JAMA Cardiology.

— Robert Preidt

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SOURCE: University of Pennsylvania, news release, June 18, 2020

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