Details

Autor(en) / Beteiligte

• Markman, Timothy M
• Brown, Chase R
• Yang, Lin
• Guandalini, Gustavo S
• Hyman, Matthew C
• Arkles, Jeffrey S
• Santangeli, Pasquale
• Schaller, Robert D
• Supple, Gregory E
• Deo, Rajat
• Nazarian, Saman
• Dixit, Sanjay
• Callans, David J
• Epstein, Andrew E
• Marchlinski, Francis E
• Groeneveld, Peter W
• Frankel, David S

Titel

Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

Ist Teil von

• Circulation (New York, N.Y.), 2021-11, Vol.144 (20), p.1590-1597

Ort / Verlag

United States

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown. This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure. Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; =0.005), preoperative muscle relaxant (odds ratio, 1.52; <0.001) or benzodiazepine (odds ratio, 1.23; =0.001) use, or opioid use in the previous 5 years (OR, 1.76; <0.0001). POU did not differ after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.1 versus 12.4%; =0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU. POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.