Heart surgery

Study Finds Heart Surgery Patients May Not Need Opioids for Pain Relief After Discharge | Health

According to a recent study, many patients who have heart surgery will not need to take opioids as pain relievers after discharge from the hospital.

The research has been published in “The Annals of Thoracic Surgery Journal”.

“In some cases, patients assume that after surgery, especially a major operation like heart surgery, they will need to go home with prescription pain relievers,” said Catherine M. Wagner, MD, of the University. from Michigan to Ann Arbor.

“This study shows that going out without opioid pain reliever after cardiac surgery is extremely well tolerated by some patients. In other words, we should not reflexively prescribe pain relievers to people after surgery just in case they need it. “, she added.

Dr Wagner and colleagues looked at data from 2019 for patients who underwent coronary artery bypass grafting (CABG), heart valve surgery, or a combination of these via a median sternotomy (a vertical incision in the center of the breast) in 10 centers participating in the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaboration.

Researchers found that more than a quarter of patients (547/1924 or 28%) had not received a prescription for opioids when they were discharged. 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-December) were more likely that other patients will be discharged from 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 time of discharge. exit.

Importantly, discharge without a prescription for opioids 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 non-opioid pain relievers,” said Dr. Wagner.

The researchers also found that of the 909 patients who had not taken opioids the day before discharge, 415 (46%) were still receiving an opioid prescription when discharged.

“The question is whether these opioid prescriptions were really necessary to relieve the pain of patients,” said Dr Wagner.

“Our study shows that, especially for patients who did not take opioids the day before discharge from hospital, discharge without opioids is safe. I think we need to make sure that only patients who really need opioids are sent home with a prescription. she added.

Opioid addiction continues to take its toll in the United States. More than 70% of overdose deaths in 2019 – more than 49,000 deaths – involved opioids, according to the U.S. Centers for Disease Control and Prevention (CDC). In 2021, more than 100,000 Americans died of drug overdoses (28.5% increase from the previous year); the CDC reports that the main 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 go home after surgery without adequate pain relief. With the best intentions of helping to relieve pain and relieve pain anxiety, discharge practices have Often made a mistake by prescribing too many narcotic pain pills rather than too few. We have learned that many of the unused and unnecessary narcotics end up in the community. This very important study will help surgeons identify patients who may come in. at home comfortably 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 pills 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 overprescribing 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 to reduce the risk of developing new persistent opioid use in patients, ”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 unnecessary opioids in communities. and put patients and their families at risk of disease. opioid diversion.

“It’s important to balance excellent pain control while limiting unnecessary opioids. We are always learning how to find the best 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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