Development of Persistent Opioid Use After Cardiac Surgery

Brown, Chase R.; Chen, Zehang; Khurshan, Fabliha; Groeneveld, Peter W.; Desai, Nimesh D.

doi:10.1001/jamacardio.2020.1445

Cited by 110 publications

(130 citation statements)

References 15 publications

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“…They found persistent use (defined as refilling an opioid prescription with 90 or 180 days postoperatively) in 10.2% of patients undergoing CABG and 8.1% of patients undergoing valve surgery. 45 Consistent with other studies on the development of chronic postsurgical pain, 46,47 persistent opioid use was more likely in younger female patients and patients with prior history of chronic pain, alcohol abuse, depression, drug use, and benzodiazepine use. The key finding from this study was that there was a direct association of MMEs prescribed at discharge with persistent opioid use.…”

Section: Pain and Cardiac Surgery Less Is Moresupporting

confidence: 88%

Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology

Clendenen

Ahlgren

Robitaille

et al. 2021

Semin Cardiothorac Vasc Anesth

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The year 2020 was marred by the emergence of a deadly pandemic that disrupted every aspect of life. Despite the disruption, notable research accomplishments in the practice of cardiothoracic anesthesiology occurred in 2020 with an emphasis on optimizing care, improving outcomes, and expanding what is possible for patients undergoing cardiac surgery. This year’s edition of Noteworthy Literature Review will focus on specific themes in cardiac anesthesiology that include preoperative anemia, predictors of acute kidney injury following cardiac surgery, pain management modalities, anticoagulation strategies after transcatheter aortic valve replacement, mechanical circulatory support, and future directions in research.

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Section: Pain and Cardiac Surgery Less Is Moresupporting

confidence: 88%

Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology

Clendenen

Ahlgren

Robitaille

et al. 2021

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

show abstract

“…Specific surgical procedures that have been linked to an increased risk of persistent postoperative opioid use include total knee arthroplasty, simple mastectomy, open cholecystectomy, open appendectomy, cesarean delivery, and cardiothoracic surgery [ 6 , 10 ]. Additionally, many studies have shown that the amount and duration of opioids prescribed at discharge contribute to the development of new persistent postoperative opioid use [ 4 , 5 , 10 , 11 ••]. Knowledge of these risk factors can aid in the early identification of patients at high risk, which may significantly alter a patient’s trajectory of care.…”

Section: Risk Factors For the Development Of New Persistent Postoperative Opioid Usementioning

confidence: 99%

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Burns

Urman

Pian

et al. 2021

Curr Pain Headache Rep

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Purpose of Review This review aims to summarize interventions used in the perioperative period to reduce the development of new persistent postoperative opioid use in opioid-naïve patients. Recent Findings The development of new persistent opioid use after surgery has recently been identified as a common postoperative complication. The existing literature suggests that interventions across the continuum of care have been shown to decrease the incidence of new persistent postoperative opioid use. Specific preoperative, intraoperative, and postoperative interventions will be reviewed, as well as the use of clinical pathways and protocols that span throughout the perioperative period. Common to many of these interventions include the use of multimodal analgesia throughout the perioperative period and an emphasis on a patient-centered, evidence-based approach to the perioperative pain management plan. Summary While the incidence of new persistent postoperative opioid use appears to be high, the literature suggests that there are both small- and large-scale interventions that can be used to reduce this. Technological advances including prescription monitoring systems and mobile applications have enabled studies to monitor opioid consumption after discharge. Interventions that occur preoperatively, such as patient education and expectation setting regarding postoperative pain management, and interventions that occur postoperatively, such as the implementation of procedure-specific, evidence-based prescribing guidelines and protocols, have been shown to reduce post-discharge opioid consumption. The use of multimodal analgesia and opioid-sparing adjuncts throughout the perioperative period is central to many of these interventions and has essentially become standard of care for management of perioperative pain.

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“…There is some evidence to suggest that orthopedic patients receive the highest doses of opioids, 7 but most series concluded that cardiac surgery is at least among the most culpable surgical specialties. 8 With as many as one-in-ten cardiac patients still using opioids at 90 days, 9 this certainly outstrips the prevalence of 3% in all-comers to surgery. 10 Perspective and scale are important:…”

Section: Churchill Would Have Approvedmentioning

confidence: 99%