Are Opioid Painkillers Needed Weeks After Heart Surgery? Maybe Not
Recovery from heart surgery can bring some pain. But a new study suggests patients don't need potentially addictive prescription opioids to control that post-op discomfort.
"This study shows that discharge without opioid pain medicine after cardiac surgery is extremely well tolerated by some patients. In other words, we should not be reflexively prescribing pain medicine to people after surgery just in case they need it," said study author Dr. Catherine Wagner, of the University of Michigan, in Ann Arbor.
The new study was published online Dec. 15 in The Annals of Thoracic Surgery. In the research, Wagner's team analyzed data from more than 1,900 U.S. patients who underwent heart bypass surgery, heart valve surgery, or a combination of both procedures. All surgeries were conducted using a vertical incision in the center of the chest. The operations were done at 10 medical centers in Michigan in 2019.
More than one-quarter (28%) of the patients did not receive an opioid painkiller prescription when they were discharged from the hospital, Wagner's group noted. Patients were less likely to have been given a prescription for an opioid if they were older or had spent more time in the hospital after surgery.
"In some cases, patients assume that after surgery, especially a big operation like cardiac surgery, that they will need to go home with prescription pain medicine," Wagner said in a journal news release.
But her team found that fewer than 2% of patients who hadn't already gotten an opioid prescription when they'd been discharged from the hospital later found they needed an opioid before their 30-day follow-up appointment.
The findings "should provide patients with reassurance that post-operative pain can be managed with non-opioid pain medications at home," Wagner said.
Dr. Yili Huang directs the Pain Management Center at Northwell Health's Phelps Hospital in Sleepy Hollow, N.Y. He wasn't involved in the new study, but said it addresses a major post-operative hazard: opioid addiction.
"Studies have shown that about 10% of patients develop chronic opioid use after cardiac surgery, and it is highly associated with the amount of opioids they are prescribed on discharge," Huang noted.
"Therefore, any data demonstrating that minimizing opioids after cardiac surgery is encouraging," he added.
Given the level of post-operative pain often encountered by recovering patients, "the fact that almost 30% of patients did not need prescription opioids after discharge is striking," Huang said. He stressed that the average bypass or valve repair patient spends at least a week in the hospital after their surgery, and many may, in fact, receive an opioid during that time.
So, "there is still a role for opioid pain care in the immediate post-operative period -- especially after cardiac surgery," Huang believes.
But the new study suggests that longer-term use of opioids after hospital discharge isn't always necessary, and "many patients do not need prescription opioids for as long as we originally thought," he said.
Dr. Thomas MacGillivray, of Houston Methodist in Texas, was not directly involved in the study but was familiar with the findings. Speaking in the journal news release, he said, "For decades, surgeons have unwittingly but substantially contributed to the opioid epidemic."
MacGillivray explained that "with the best intentions to help relieve pain and alleviate anxiety about pain, discharge practices have frequently erred on the side of prescribing too many rather than too few narcotic pain pills. We have learned that many of the unused, unneeded narcotics end up in the community. This very important study will help surgeons identify patients who may comfortably be discharged home without narcotics."
According to recent data from the U.S. Centers for Disease Control and Prevention, at least 70% of U.S. deaths in 2019 linked to drug overdose -- about 49,000 lives lost -- were linked to opioids.
The U.S. National Institute on Drug Abuse has more on prescription opioids.
SOURCES: Yili Huang, DO, MBA, director, Pain Management Center, Northwell Health's Phelps Hospital, Sleepy Hollow, N.Y.; The Annals of Thoracic Surgery, news release, Dec. 16, 2021
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