• Kathleen C Clement, Joseph K Canner, Jennifer S Lawton, Whitman Glenn J R GJR Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., Michael C Grant, and Marc S Sussman.
• Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
• J. Thorac. Cardiovasc. Surg. 2020 Oct 1; 160 (4): 954-963.e4.

ObjectiveDeaths 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.MethodsInsurance 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.ResultsAmong 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.ConclusionsNew 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.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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