The Incidence of New Persistent Opioid Use Following Cardiac Surgery via Sternotomy

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

“…Patient-related risk factors associated with new persistent opioid use included younger age, 4,62 female gender, 4,57,62 Black race, 62 higher Charlson comorbidity index, 5,62 congestive heart failure, 4 chronic lung disease, 4 chronic obstructive pulmonary disease (COPD), 5,57 diabetes, 4 liver disease, 4 kidney failure, 4 rheumatoid arthritis, 4 chronic pain disorders, 4,62 anxiety, 57 history of tobacco use, 57,60,62 alcoholism, 4 or prior substance abuse 57,62 and preoperative use of benzodiazepines, 4 muscle relaxants, 4 neuropathic pain medications, 5 NSAIDs, 5 and nitrates 5 (category B1 evidence 4 and category B2 evidence 5,57,60,62 ).…”

“…The overall incidence of new persistent opioid use after sternotomy for cardiac surgery was 4.6% to 10.2% among opioid-naïve patients. [4][5][6] It was reported to be between 3.2% and 10.2% after CABG 4,57,58 surgery, 5.1% and 8.1% after valve 4,59 surgery, and 5.1% after open aortic 60 surgery (category B1 evidence 4 and category B2 evidence 5,6,[57][58][59][60] ). A meta-analysis also reported a persistent opioid use rate of 5.7% after cardiac surgery (category A1 evidence).…”

“…About 5% to 10% of opioid-naïve patients undergoing open cardiac surgery become new persistent opioid users due to opioid exposure during surgery. 4–6 Opioids are also associated with serious side effects, including respiratory depression. 7…”

“…About 5% to 10% of opioid-naïve patients undergoing open cardiac surgery become new persistent opioid users due to opioid exposure during surgery. [4][5][6] Opioids are also associated with serious side effects, including respiratory depression. 7 With the advancement of surgical approaches to cardiac disease, perioperative pain management has continued to evolve to expedite the patient's recovery after cardiac surgery.…”

Laying the First Brick: A Foundation for Medical Investigation Through Big Data

“…6 Depending on the source, incidences of new POU after, for example, cardiac surgery may range from 3% to 18% with variation largely stemming from the data source, which may be confined to only a single institution and limited to Medicare recipients in isolation or rely only on insurance claims data. 7,8 Therefore, much of our knowledge on opioid administration is in surrogate and yielded from patient groups that may not adequately reflect the greater patient population. This concern is mitigated, at least in part, by the use of vast integrated data registries such as those offered by MPOG, the National Anesthesia Clinical Outcomes Registry (NACOR), National Surgical Quality Program (NSQIP), or Society of Thoracic Surgeons (STS), where findings stand to be less inferential compared with other smaller or specialized observational databases.…”