Brescia AA, Clark MJ, Theurer PF, Lall SC, Nemeh HW, Downey RS, Martin DE, Dabir RR, Asfaw ZE, Robinson PL, Harrington SD, Gandhi DB, Waljee JF, Englesbe MJ, Brummett CM, Prager RL, Likosky DS, Kim KM, and Lagisetty KH. Establishment and Implementation of Evidence-Based Opioid Prescribing Guidelines in Cardiac Surgery. Ann Thorac Surg 2020.
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.
ePub ahead of print