Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

Abstract

Background: Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown. Methods: This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure. Results: Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; P =0.005), preoperative muscle relaxant (odds ratio, 1.52; P <0.001) or benzodiazepine (odds ratio, 1.23; P =0.001) use, or opioid use in the previous 5 years (OR, 1.76; P <0.0001). POU did not differ after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.1 versus 12.4%; P =0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU. Conclusions: POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.

Erector Spinae Plane Block Decreases Narcotic Requirements in Patients Undergoing Subcutaneous Implantable Cardioverter-defibrillator Placement Under Sedation

“…As a matter of fact, Markman et al showed that the incidence of POU in even opioid-naive patients can be as high as 12%, and therefore a multimodal pain approach, including truncal blocks, is recommended to reduce opioid use in these patients. 20 In addition, recent studies have shown that even a small reduction in intraoperative opioid use can yield a significant decrease in postoperative complications, particularly in high-risk patients, 21 , 22 although large studies are needed to determine this effect.…”

Telehealth of cardiac devices for CVD treatment

“…Prescription opioids after surgery including heart implantation became the major contributor to the opioid epidemic (Puymirat et al, 2016). A study demonstrated that approximately 12% of patients continued using opioids even after 30 days of surgery (Markman et al, 2021). In 2017, the Department of Health and Human services declared an opioid epidemic in the United States.…”

“…Opioids and endogenous derivatives including endorphins exert potent activities within the central, and peripheral nervous systems and subsequently regulate blood pressure, heart rate, and thermogenesis (Bellandi et al, 2016). Thus, postoperative opioid use should be restricted and regulated by multimodality approaches including patient education and being replaced with nonopioid analgesics (Markman et al, 2021).…”

Trends in Opioid Use After Cardiac Implantable Electronic Device Procedures in the United States Between 2004 and 2020

“…We have recently shown that persistent opioid use is common after cardiac implantable electronic device (CIED) procedures, despite the perception that these are minimally invasive procedures with low periprocedural pain levels. 4 A prescribed dose >135 mg oral morphine equivalents (OME) after CIED procedures is associated with increased risk of persistent opioid use. In this study, we investigated the trends in opioid prescriptions after CIED procedures from 2004 to 2020 with a focus on whether regulatory guidelines have achieved their intended effects.…”