Thousands of cardiac surgery patients develop prolonged opioid use

Opioid prescriptions are common at hospital discharge after cardiac surgery but many patients are receiving higher than recommended doses.

As well, one in seven patients continue to receive opioids 3–12 months after surgery.

An Australian study of 2,205 patients undergoing cardiac surgery at the Austin Hospital between 2012 and 2019 found three-quarters (76.4%) were prescribed opioids on hospital discharge.

The median discharge prescription was 150 mg oral morphine equivalents and 52.8% were slow-release formulations.

The Australian and New Zealand College of Anaesthetists (ANZCA) and the TGA have both advised against using slow-release (SR) opioids in the treatment of acute pain because their use in opioid naïve patients has been associated with increased risk of persistent use.

Interestingly, 60.0% of all discharge prescriptions for opioids were for patients who had not received opioids the day before their discharge.

“Our findings imply that a significant proportion of patients may be receiving excessive discharge opioid therapy after cardiac surgery.”

The study, published in Heart, Lung and Circulation, found patients who were young, overweight and current smokers were more likely to be prescribed opioids on discharge.

“Likewise, CABG only surgery and less complex procedures were more likely to be prescribed opioids at discharge.”

“We hypothesise that patients undergoing more complex procedures have longer hospital stay, have more time to recover after surgery and thus require less opioids on discharge.”

The study, led by anaesthetist Dr Victor Hui, said based on the numbers of cardiac surgeries performed in Australia potentially almost 2,000 patients every year could subsequently develop persistent opioid use.

The authors said their findings suggested an ongoing need for education amongst junior doctors who are often the most common prescribers of opioids for post-surgical patients.

“Identification of patients who may be at risk of high dose opioid prescriptions is important to target opioid stewardship program resources into the most at-risk patient groups.”

“Implementation of an opioid stewardship program can reduce both discharge opioids prescribed and proportion of SR opioids prescribed.”

Dr Hui told the limbic that all clinicians should be aware of the excessive opioid prescriptions and the prevalence of persistent opioids after surgery.

“Cardiologists are routinely involved in the care of the post cardiac surgical patient and this provides an opportunity to educate patients on the risk of opioid dependence in those who are persistently taking opioids after surgery,” he said.

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