Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Md.
J Thorac Cardiovasc Surg. 2020 Oct;160(4):954-963.e4. doi: 10.1016/j.jtcvs.2019.09.137. Epub 2019 Oct 10.
Deaths from prescription opioid overdose have quadrupled in the past 15 years, and no studies have evaluated appropriate opioid prescribing after cardiac surgery. The aim of this study is to quantify the amount of outpatient opioids prescribed to patients after coronary artery bypass grafting and determine the incidence and risk factors for new persistent opioid use after coronary artery bypass grafting.
Insurance claim data from privately insured opioid-naïve patients who underwent coronary artery bypass grafting from 2014 to 2016 were evaluated. New persistent opioid use was defined as patients who filled an opioid prescription in the perioperative period and filled opioid prescriptions between 90 and 180 days after surgery. Multivariable logistic regression was used to determine the preoperative and operative factors associated with new persistent opioid use.
Among 7292 opioid-naïve patients undergoing coronary artery bypass grafting, 5628 (77.2%) filled opioid prescriptions in the perioperative period, and 590 (8.1%) had new persistent opioid use. Female gender (odds ratio [OR], 1.30; confidence interval [CI], 1.05-1.61; P = .018), anxiety (OR, 1.40; CI, 1.09-1.81; P = .009), tobacco use (OR, 1.34; CI, 1.08-1.65; P = .007), prior substance abuse (OR, 1.99; CI, 1.16-3.41; P = .013), chronic obstructive pulmonary disease (OR, 1.29; CI, 1.02-1.63; P = .037), living in the Southern United States (OR, 1.46; CI, 1.21-1.77; P < .001), and increased amount of opioids prescribed in the perioperative period (OR, 1.016; CI, 1.014-1.018; P < .001) were independently associated with new persistent opioid use.
New persistent opioid use after coronary artery bypass grafting is surprisingly common. Prospective studies are needed to determine the opioid requirements of patients after coronary artery bypass grafting to prevent opioid dependence.
在过去的 15 年中，处方类阿片药物过量导致的死亡人数增加了四倍，且目前尚无研究评估过心脏手术后的阿片类药物合理处方。本研究旨在量化冠状动脉旁路移植术后门诊开出的阿片类药物数量，并确定冠状动脉旁路移植术后新发持续性阿片类药物使用的发生率和风险因素。
评估了 2014 年至 2016 年期间接受冠状动脉旁路移植术的、未曾使用过阿片类药物的私人保险患者的保险索赔数据。新持续性阿片类药物使用定义为在围手术期内开具阿片类药物处方且在术后 90 至 180 天内再次开具阿片类药物处方的患者。采用多变量逻辑回归确定与新发持续性阿片类药物使用相关的术前和手术因素。
在 7292 名未曾使用过阿片类药物的接受冠状动脉旁路移植术的患者中，5628 名（77.2%）在围手术期内开具了阿片类药物处方，590 名（8.1%）有新持续性阿片类药物使用。女性（比值比[OR]，1.30；置信区间[CI]，1.05-1.61；P=0.018）、焦虑（OR，1.40；CI，1.09-1.81；P=0.009）、吸烟（OR，1.34；CI，1.08-1.65；P=0.007）、既往物质滥用（OR，1.99；CI，1.16-3.41；P=0.013）、慢性阻塞性肺疾病（OR，1.29；CI，1.02-1.63；P=0.037）、居住在美国南部（OR，1.46；CI，1.21-1.77；P<0.001）以及围手术期内开具的阿片类药物剂量增加（OR，1.016；CI，1.014-1.018；P<0.001）与新发持续性阿片类药物使用独立相关。
冠状动脉旁路移植术后新发持续性阿片类药物使用的情况令人惊讶地普遍。需要前瞻性研究来确定冠状动脉旁路移植术后患者的阿片类药物需求，以预防阿片类药物依赖。
