Some patients may be safely discharged without opioids after cardiac surgery
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For some patients who undergo cardiac surgery, discharge without an opioid prescription for pain management is feasible, researchers reported in the Annals of Thoracic Surgery.
The researchers retrospectively analyzed 1,924 patients (mean age, 64 years; 25% women) who underwent cardiac surgery (CABG and/or valve surgery) at one of 10 centers in 2019 who were not taking opioids at the time of their procedure.
“Postoperative opioid prescribing after cardiac and thoracic surgery has been one of the main quality improvement goals of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative,” Catherine M. Wagner, MD, cardiothoracic surgery resident at the University of Michigan, said in a prerecorded press briefing. “Our research in this area has helped us understand how many opioid pills most patients require after cardiac surgery and led to postoperative prescribing recommendations. And yet, we found ourselves wondering, does every patient require an opioid prescription after cardiac surgery? If not, what characteristics do the patients who do not receive an opioid prescription at discharge have? We wanted to understand what are predictors of not needing an opioid prescription after cardiac surgery.”
Among the cohort, 28% of patients were discharged without an opioid prescription. In addition, 47% did not take any opioids on the day before discharge, and of those, 46% nonetheless received an opioid prescription at discharge, the researchers wrote.
Predictors of being discharged without an opioid prescription were older age (OR per 10 years = 1.24; 95% CI, 1.08-1.43; P = .003), longer length of hospital stay (OR per day = 1.11; 95% CI, 1.05-1.18; P < .001) and undergoing surgery in the last 3 months of the study period (OR vs. first 3 months = 1.89; 95% CI, 1.29-2.79; P < .001), whereas predictors of receiving an opioid prescription were depression (OR = 0.64; 95% CI, 0.45-0.92; P = .02), non-Black and non-white race (OR = 0.43; 95% CI, 0.19-0.95; P = .04) and using more pills on the day before discharge (OR per each additional pill = 0.22; 95% CI, 0.17-0.28; P < .001), according to the researchers.
Among patients who were discharged without an opioid prescription, 1.8% subsequently received an opioid prescription before their 30-day follow-up appointment.
“Not every patient will require an opioid prescription after cardiac surgery,” Wagner said during the briefing. “In select patients, discharge without an opioid prescription is extremely well-tolerated, with the vast majority of patients doing well, without requiring any opioids at home. These data suggest that we may reconsider providing patients with an opioid prescription just in case they may end up needing it. We should continue to consider the level of opioid use during a patient’s time in the hospital to guide prescribing at discharge.”
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