Select Heart Surgery Patients May Not Need Opioid Pain Meds when Discharged

CHICAGO — Many patients who undergo heart surgery may be able to safely and effectively control postoperative pain without opioids after hospital discharge, according to research published online today in The Annals of Thoracic 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,” said Catherine Wagner, MD, from the University of Michigan in Ann Arbor. “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.”

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

The researchers found that more than one-fourth of patients (547/1,924 or 28%) did not receive an opioid prescription at the time of discharge. Patients who were older, spent more time in the hospital after surgery, or who underwent surgery and were discharged during the last 3 months of the study period (October–December) were more likely than other patients to leave the hospital without an opioid prescription. Conversely, patients with a history of depression, those who were treated with opioids on the day prior to discharge, or patients whose race was non-black and non-white were more likely to receive an opioid prescription at discharge.

Importantly, discharge without an opioid prescription appears to have been well tolerated, as fewer than 2% of patients subsequently required a prescription after their discharge and before their 30-day follow-up appointment.

“This study’s findings should provide patients with reassurance that postoperative pain can be managed with non-opioid pain medications at home,” said Dr. Wagner.