According to a recent study, many patients who undergo heart surgery will not need to take opioids for pain relief after discharge from hospital.
The research was published in “The Annals of Thoracic Surgery Journal”.
“In some cases, patients assume that after surgery, especially a big operation like heart surgery, they will have to go home with prescription painkillers,” said Catherine M. Wagner, MD, of the University of Michigan to Ann Arbor.
“This study shows that discharge without opioid painkillers after cardiac surgery is extremely well tolerated by some patients. In other words, we should not reflexively prescribe painkillers to people after surgery just in case they need them. “, she added.
Dr. Wagner and his colleagues looked at 2019 data for patients who underwent coronary artery bypass grafting (CABG), heart valve surgery, or a combination of these operations via a median sternotomy (a vertical incision down the center of the chest) in 10 centers participating in the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative.
Researchers found that more than a quarter of patients (547/1,924 or 28%) had not received an opioid prescription at discharge. Older patients, who spent more time in the hospital after surgery or who had surgery and were discharged in the last 3 months of the study period (October to December) were more likely than other patients to leave the hospital without an opioid prescription.
Conversely, patients with a history of depression, those who were treated with opioids the day before discharge, or patients whose race was neither black nor white were more likely to receive an opioid prescription at the exit.
Importantly, non-prescription opioid discharge appears to have been well tolerated, as less than 2% of patients subsequently required a prescription after discharge and before their 30-day follow-up appointment.
“The results of this study should reassure patients that postoperative pain can be managed at home with nonopioid pain medications,” Dr. Wagner said.
The researchers also found that of the 909 patients who had taken no opioids the day before discharge, 415 (46%) were still receiving an opioid prescription at discharge.
“One has to wonder if these opioid prescriptions were really necessary to relieve patients’ pain,” Dr. Wagner said.
“Our study shows that, especially for patients who were off opioids the day before they left hospital, an opioid-free discharge is safe. I think we need to make sure that only patients who really need opioids be sent home with a prescription.” she added.
Opioid addiction continues to wreak havoc on life in the United States. More than 70% of overdose deaths in 2019 – more than 49,000 deaths – involved opioids, according to the US Centers for Disease Control and Prevention (CDC). In 2021, more than 100,000 Americans died from drug overdoses (28.5% increase over the previous year); the CDC reports that the primary driver of these deaths was opioids.
“For decades, surgeons have unwittingly but substantially contributed to the opioid epidemic,” said Thomas E. MacGillivray, MD, of Houston Methodist in Texas, who was not directly involved in this research.
“No one wants a patient to be sent home after surgery without adequate pain relief. With the best intentions to help relieve pain and alleviate pain anxiety, discharge practices have often erred in prescribing too much rather than too little narcotic pain medication. . We have learned that many unused and unnecessary narcotics end up in the community. This very important study will help surgeons identify patients who can comfortably be discharged home without narcotics,” he added.
Dr. Wagner explained that before the relatively recent awareness of the opioid epidemic, patients were often prescribed 50 to 100 opioid tablets after surgery for a variety of reasons. Independent research has shown that leftover drugs can be diverted to the community, contributing to the opioid epidemic.
“With increased attention to the overprescribing of opioids for the treatment of pain after surgery, national efforts such as prescribing guidelines and patient education programs have begun to help limit unnecessary opioids. in the community and reduce the risk of patients developing persistent new opioid use,” she said.
Going forward, researchers plan to ensure that only patients who really need opioids are sent home with a prescription, while eliminating “just in case” prescriptions that leave unneeded opioids in communities. and put patients and family members at risk for the disease. diversion of opioids.
“It is important to balance excellent pain control while limiting unnecessary opioids. We are always learning how to best strike this balance for our patients and recommend that patients always work closely with their physician/provider teams to decide what is best for them,” said Dr. Wagner.
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