Predictors of new persistent opioid use after coronary artery bypass grafting

Kathleen C Clement; Joseph K Canner; Jennifer S Lawton; Glenn J R Whitman; Michael C Grant; Marc S Sussman

doi:10.1016/j.jtcvs.2019.09.137

Predictors of new persistent opioid use after coronary artery bypass grafting

J Thorac Cardiovasc Surg. 2020 Oct;160(4):954-963.e4. doi: 10.1016/j.jtcvs.2019.09.137. Epub 2019 Oct 10.

Authors

Kathleen C Clement¹, Joseph K Canner², Jennifer S Lawton¹, Glenn J R Whitman¹, Michael C Grant³, Marc S Sussman⁴

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
² Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Md.
³ Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
⁴ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: [email protected].

PMID: 32007246
DOI: 10.1016/j.jtcvs.2019.09.137

Abstract

Objective: Deaths from prescription opioid overdose have quadrupled in the past 15 years, and no studies have evaluated appropriate opioid prescribing after cardiac surgery. The aim of this study is to quantify the amount of outpatient opioids prescribed to patients after coronary artery bypass grafting and determine the incidence and risk factors for new persistent opioid use after coronary artery bypass grafting.

Methods: Insurance claim data from privately insured opioid-naïve patients who underwent coronary artery bypass grafting from 2014 to 2016 were evaluated. New persistent opioid use was defined as patients who filled an opioid prescription in the perioperative period and filled opioid prescriptions between 90 and 180 days after surgery. Multivariable logistic regression was used to determine the preoperative and operative factors associated with new persistent opioid use.

Results: Among 7292 opioid-naïve patients undergoing coronary artery bypass grafting, 5628 (77.2%) filled opioid prescriptions in the perioperative period, and 590 (8.1%) had new persistent opioid use. Female gender (odds ratio [OR], 1.30; confidence interval [CI], 1.05-1.61; P = .018), anxiety (OR, 1.40; CI, 1.09-1.81; P = .009), tobacco use (OR, 1.34; CI, 1.08-1.65; P = .007), prior substance abuse (OR, 1.99; CI, 1.16-3.41; P = .013), chronic obstructive pulmonary disease (OR, 1.29; CI, 1.02-1.63; P = .037), living in the Southern United States (OR, 1.46; CI, 1.21-1.77; P < .001), and increased amount of opioids prescribed in the perioperative period (OR, 1.016; CI, 1.014-1.018; P < .001) were independently associated with new persistent opioid use.

Conclusions: New persistent opioid use after coronary artery bypass grafting is surprisingly common. Prospective studies are needed to determine the opioid requirements of patients after coronary artery bypass grafting to prevent opioid dependence.

Keywords: coronary artery bypass; opiod dependence.

Publication types

Webcast

MeSH terms

Administrative Claims, Healthcare
Aged
Ambulatory Care
Analgesics, Opioid / administration & dosage*
Analgesics, Opioid / adverse effects
Coronary Artery Bypass / adverse effects*
Databases, Factual
Drug Administration Schedule
Drug Prescriptions
Female
Humans
Male
Middle Aged
Opioid-Related Disorders / prevention & control
Pain, Postoperative / diagnosis
Pain, Postoperative / drug therapy*
Pain, Postoperative / etiology
Practice Patterns, Physicians'
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome

Substances

Analgesics, Opioid