Establishment and Implementation of Evidence-Based Opioid Prescribing Guidelines in Cardiac Surgery.

Authors

Alexander A Brescia
Melissa J Clark
Patricia F Theurer
Shelly C Lall
Hassan W Nemeh
Richard S Downey
David E Martin
Reza R Dabir, Beaumont Health
Zewditu E Asfaw
Phillip L Robinson
Steven D Harrington
Divyakant B Gandhi
Jennifer F Waljee
Michael J Englesbe
Chad M Brummett
Richard L Prager
Donald S Likosky
Karen M Kim
Kiran H Lagisetty

Document Type

Article

Publication Date

10-1-2021

Publication Title

The Annals of thoracic surgery

Abstract

BACKGROUND: Despite the risk of new persistent opioid use after cardiac surgery, postdischarge opioid use has not been quantified and evidence-based prescribing guidelines have not been established.

METHODS: Opioid-naive patients undergoing primary cardiac surgery via median sternotomy between January and December 2019 at 10 hospitals participating in a statewide collaborative were selected. Clinical data were linked to patient-reported outcomes collected at 30-day follow-up. An opioid prescribing recommendation stratified by inpatient opioid use on the day before discharge (0, 1-3, or ≥4 pills) was implemented in July 2019. Interrupted time-series analyses were performed for prescription size and postdischarge opioid use before (January to June) and after (July to December) guideline implementation.

RESULTS: Among 1495 patients (729 prerecommendation and 766 postrecommendation), median prescription size decreased from 20 pills to 12 pills after recommendation release (P < .001), while opioid use decreased from 3 pills to 0 pills (P < .001). Change in prescription size over time was +0.6 pill/month before and -0.8 pill/month after the recommendation (difference = -1.4 pills/month; P = .036). Change in patient use was +0.6 pill/month before and -0.4 pill/month after the recommendation (difference = -1.0 pills/month; P = .017). Pain levels during the first week after surgery and refills were unchanged. Patients using 0 pills before discharge (n = 710) were prescribed a median of 0 pills and used 0 pills, while those using 1 to 3 pills (n = 536) were prescribed 20 pills and used 7 pills, and those using greater than or equal to 4 pills (n = 249) were prescribed 32 pills and used 24 pills.

CONCLUSIONS: An opioid prescribing recommendation was effective, and prescribing after cardiac surgery should be guided by inpatient use.

Volume

112

Issue

4

First Page

1176

Last Page

1185

Recommended Citation

Brescia AA, Clark MJ, Theurer PF, Lall SC, Nemeh HW, Downey RS, Martin DE, Dabir RR, Asfaw ZE, Robinson PL, Harrington SD, Gandhi DB, Waljee JF, Englesbe MJ, Brummett CM, Prager RL, Likosky DS, Kim KM, Lagisetty KH; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC); Michigan Opioid Prescribing Engagement Network (Michigan OPEN). Establishment and Implementation of Evidence-Based Opioid Prescribing Guidelines in Cardiac Surgery. Ann Thorac Surg. 2021 Oct;112(4):1176-1185. doi: 10.1016/j.athoracsur.2020.11.015. Epub 2020 Dec 4. PMID: 33285132; PMCID: PMC8550876.

DOI

10.1016/j.athoracsur.2020.11.015

ISSN

1552-6259

PubMed ID

33285132