Approximately 12% of patients who take opioids following a cardiac implantable electronic device (CIED) procedure develop persistent opioid use (POU) within the next 180 days, according to new data published in Circulation.
Researchers evaluated data from 143,400 patients who underwent CIED procedures between 2004 and 2018. All data was from the Optum Clinformatics Data Mart, a database of administrative health claims for members’ commercial and Medicare Advantage health plans.
Sixty percent of patients were men, and the median patient age was 67.4 years old.
In the analysis, 21% of patients filled an opioid prescription in the five years after their procedure; 11% filled an opioid prescription within 14 days.
In that cohort, POU occurred in 12.4% of patients 30 to 180 days after the surgery.
The authors found that the chance of developing POU was greater for patients who had a history of drug abuse, preoperative muscle relaxant or benzodiazepine use, or opioid use in the preceding five years.
Another key finding from the analysis was that prescriptions of greater than 135 mg oral morphine equivalent (OME) were associated with an elevated risk of POU compared to patients that were prescribed a smaller dose.
"All physicians who perform CIED procedures and care for these patients should be aware of the risk of persistent opioid use,” wrote lead author Timothy M. Markman, MD, with the cardiovascular division at Perelman School of Medicine at the University of Pennsylvania, and colleagues. “Postoperative opioid use should be limited using a multimodality approach including patient education, procedural strategies such as peripheral nerve blocks, and use of nonopioid analgesics.”
Markman et al., noted that the study did have limitations.
“We were unable to identify opioid prescriptions written but not filled by patients, filled by patients using a different pharmacy benefit, or paid for out of pocket, potentially underestimating total prescription rates," they wrote. "In addition, this database consists of adults with private insurance or Medicare-managed coverage and may not be generalizable to other populations.”
Read the full study here.