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Why Are 1 in 10 Heart Surgery Patients Prescribed Opioids Still Taking them 3 Months Later?

Almost 10% of patients who are on prescription opioid medications after heart surgery continue to use opioids more than 90 days after their operation, according to a new study. In an article in JAMA Cardiology, researchers at the Perelman School of Medicine at the University of Pennsylvania noted that there was a direct link between the dosage of opioids – or oral morphine equivalent (OME) – that were prescribed when a patient was discharged and the likelihood that the person would still be on opioids 90 to 180 days after their surgery. Researchers found that individuals who were prescribed more than 300mg OMEs (equivalent to about 40 tablets of 5mg oxycodone) were at a much higher risk of prolonged opioid use compared to patients who were prescribed a lower dosage.

Opioid use in the United States is considered a public health emergency, and opioid-related deaths, which increased to 47,600 in 2017, account for 67.8% of all drug overdoses. The Perelman School of Medicine study authors note that surgery is a risk factor for new, persistent opioid use. Overprescribing opioids during the postoperative period leads to a higher opioid consumption regardless of the level of postoperative pain, they found.

The retrospective cohort study used data from a national administrative claims database from January 1, 2004, to December 31, 2016 and included 35, 817 patients who underwent coronary artery bypass grafting (25,673 or 71.7%) and heart valve (10,144 or 28.3%) procedures. All patients were opioid-naive within 180 days before the index procedure.

Researchers used OptumInsights Informatics DataMart (Optum), a large, private payer administrative claims database. They explained in the JAMA Cardiology article that the prescription data in Optum are based on prescriptions filled at a pharmacy, and that patients were classified as taking an opioid if they were prescribed drugs containing hydrocodone, oxycodone, tramadol, codeine, hydromorphone, morphine, transdermal fentanyl, tapentadol, or oxymorphone. Except for transdermal fentanyl, only tablet medications were studied.

About 60% of the coronary artery bypass grafting (CABG) patients and 63% of the valve surgery patients filled an opioid prescription within two weeks of their surgery. Some 9.6% of the cardiac surgery patients were still filling these prescriptions from three to six months post-surgery, researchers found, and the refill rate was slightly higher among CABG patients. Close to 8% of the CABG patients were still filling their opioid prescription 180 to 270 days after their operation.

The researchers learned that there was a higher incidence rate among younger patients, women, and patients with preexisting medical conditions like chronic lung disease, kidney failure, and diabetes.

“Opioids are used extensively after cardiothoracic surgery and nearly 1 of 10 patients will continue to use opioids over 90 days after surgery,” the authors concluded. “Furthermore, higher OMEs prescribed at discharge were significantly associated with developing persistent use. Centers must adopt protocols to increase patient education and limit opioid prescriptions after discharge.”

Source:

Development of persistent opioid use after cardiac surgery. JAMA Cardiology.

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