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The Annals of thoracic surgery


BACKGROUND: Despite the risk of new persistent opioid use after cardiac surgery, post-discharge opioid use has not been quantified and evidence-based prescribing guidelines have not been established.

METHODS: Opioid-naïve patients undergoing primary cardiac surgery via median sternotomy between January-December 2019 at 10 hospitals participating in a statewide collaborative were selected. Clinical data were linked to patient-reported outcomes collected at 30-day follow-up. An opioid prescribing recommendation stratified by inpatient opioid use on the day before discharge (0, 1-3, or ≥4 pills) was implemented in July 2019. Interrupted time-series analyses were performed for prescription size and post-discharge opioid use before (January-June) and after (July-December) guideline implementation.

RESULTS: Among 1495 patients (729 pre- and 766 post-recommendation), median prescription size decreased from 20 to 12 pills after recommendation release (p<0.001), while opioid use decreased from 3 to 0 pills (p<0.001). Change in prescription size over time was +0.6 pills/month before and -0.8 pills/month after the recommendation (difference: -1.4 pills/month, p=0.036). Change in patient use was +0.6 pills/month before and -0.4 pills/month after the recommendation (difference: -1.0 pills/month, p=0.017). Pain levels during the first week after surgery and refills were unchanged. Patients using 0 pills before discharge (n=710) were prescribed a median of 0 pills and used 0, while those using 1-3 pills (n=536) were prescribed 20 and used 7, and those using ≥4 pills (n=249) were prescribed 32 and used 24.

CONCLUSIONS: An opioid prescribing recommendation was effective, and prescribing after cardiac surgery should be guided by inpatient use.

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ePub ahead of print