Several risk factors for new persistent opioid use after coronary artery bypass grafting (CABG) were identified, including female sex, anxiety, tobacco use, prior substance abuse, and chronic obstructive pulmonary disease (COPD), according to a study published in the Journal of the Thoracic and Cardiovascular Surgery.In this study, data from insurance claims of privately insured opioid-naive patients who underwent CABG between 2014 and 2015 were examined (n=7292). New persistent opioid use was defined as opioid prescriptions filled in the perioperative period as well as between 90 and 180 days after surgery.
The majority of patients who underwent CABG in this cohort filled opioid prescriptions in the perioperative period (77.2%), and 590 patients (8.1%) had new persistent opioid use.
Independent risk factors associated with new persistent opioid use included female sex (odds ratio [OR], 1.30; 95% CI, 1.05-1.61; P =.018), anxiety (OR, 1.40; 95% CI, 1.09-1.81; P =.009), tobacco use (OR, 1.34; 95% CI, 1.08-1.65; P =.007), prior substance abuse (OR, 1.99; 95% CI, 1.16-3.41; P =.013), COPD (OR, 1.29; 95% CI, 1.02-1.63; P =.037), living in the southern United States (OR, 1.46; 95% CI, 1.21-1.77; P <.001), and higher amounts of opioids prescribed perioperatively (OR, 1.016; 95% CI, 1.014-1.018; P <.001).
Study limitations include its retrospective nature, the lack of uninsured patients or of patients with Medicaid or Medicare, and the lack of information regarding the amount of opioids actually taken by the patient.
“Opioid prescribing guidelines may curtail excessive opioid prescribing in patients who undergo cardiac surgery and may reduce the risk of new persistent opioid use in this population,” noted the study authors.
Clement KC, Canner JK, Lawton JS, et al. Predictors of new persistent opioid use after coronary artery bypass grafting [published online October 10, 2019]. J Thorac Cardiovasc Surg. doi: 10.1016/j.jtcvs.2019.09.137