Ann Arbor, Michigan: Some patients who have undergone cardiac surgery might not necessarily require an opioid prescription on discharge, suggests a recent study. This suggests that increasing the number of patients discharged without an opioid prescription may be considered for quality improvement.
The study, published in The Annals of Thoracic Surgery, found that discharging select patients without an opioid prescription after cardiac surgery was well-tolerated. And, there was a low incidence of post-discharge opioid prescriptions.
The findings of the study are significant as the opioid crisis remains important for healthcare decision-making, with surgeons especially aware of the long-term effects of their prescriptions.
In the study, Alexander A. Brescia, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, and colleagues aimed to identify patient predictors of not receiving an opioid prescription at the time of discharge home after cardiac surgery in a multicenter analysis.
For this purpose, the researchers retrospectively identified opioid-naïve patients undergoing coronary artery bypass grafting and/or valve surgery through a sternotomy at 10 centers from a prospectively maintained data set. Opioid-naïve was defined as not taking opioids at the time of admission.
The primary outcome was a discharge without an opioid prescription. To identify predictors of discharge without an opioid prescription, mixed-effects logistic regression was performed. Postdischarge opioid prescribing was monitored to assess patient tolerance of discharge without an opioid prescription.
Among 1924 eligible opioid-naïve patients, the mean age was 64 ± 11 years, and 25% were women.
Key findings include:
In total, 28% of all patients were discharged without an opioid prescription.
On multivariable analysis, older age, longer length of hospital stay, and undergoing surgery during the last 3 months of the study were independent predictors of discharge without an opioid prescription, whereas depression, non-Black and non-White race, and using more opioid pills on the day before discharge were independent predictors of receiving an opioid prescription.
Among patients discharged without an opioid prescription, 1.8% (10 of 547) were subsequently prescribed an opioid.
"Discharging select patients without an opioid prescription after cardiac surgery appears well-tolerated, with a low incidence of postdischarge opioid prescriptions," wrote the authors. "Increasing the number of patients discharged without an opioid prescription may be an area for quality improvement."
Reference:
The study titled, "Predictors of Discharge Home Without Opioids After Cardiac Surgery: A Multicenter Analysis," was published in The Annals of Thoracic Surgery.
DOI: https://doi.org/10.1016/j.athoracsur.2021.10.005