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Researchers who examined data from 2019 patients who had heart surgery at 10 centers participating in the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative found that opioid prescriptions were not given to more than one-quarter of patients. Older patients and those who spent more time in the hospital after surgery were among those least likely to be given opioids. According to the research, published in The Annals of Thoracic Surgery, fewer than 2% of those not given opioids subsequently needed a prescription after discharge and before their 30-day follow-up.
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— Kate Jackson, editor |
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Not All Heart Surgery Patients Need Opioids on Discharge
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 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,” says Catherine M. 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.”
Wagner and colleagues examined data from 2019 for patients who underwent coronary artery bypass grafting, 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 three months of the study period (October to 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 nonwhite 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 nonopioid pain medications at home,” Wagner says.
The researchers also found that among the 909 patients who did not take any opioids on the day before discharge, 415 (46%) still received an opioid prescription at discharge.
“One should consider whether these opioid prescriptions were truly necessary for patient pain relief,” Wagner says. “Our study shows that, particularly for patients who did not take any opioids on the day before leaving the hospital, discharge without opioids is safe. I think we need to ensure that only patients who truly need opioids get sent home with a prescription.”
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As the Pandemic Turns
When COVID-19 disrupted food systems and triggered an economic crisis in 2020, food insecurity—particularly in older adults—intensified as a public health issue. Persistence of the pandemic continues to drive food insecurity in this population. Read more »
Heart Disease & Flu: A Dangerous Combination
A link between heart disease and influenza makes the need for vaccination all the more urgent, as vaccination could significantly reduce the risk of a serious or fatal cardiac event in a large population of patients. Read more »
Medication Delivery Directly to the Lungs
An innovative method for delivering medicine directly to the lungs, experts say, could be a game-changer for vaccinations and other medical treatments. Read more »
Web Exclusive: Burned Out by the Pandemic? War Zone Medicine Tips From an Army Physician-Turned-Geriatrician
Geriatricians may be feeling burned out by this pandemic, which particularly threatens older patients. A physician offers some war-zone medicine tips to help physicians keep going in stressful medical situations. Read more » |
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Innovative Toilet for Convalescent Care
The Laveo by Dry Flush is an innovative and practical way to provide on-the-spot access to a portable electric toilet to people in convalescent care. The waterless, odorless, chemical-free, no-freeze, low-maintenance toilet is compact and weighs only 29 pounds. Learn more »
Postsurgical Shoulder Support
The PRO Shoulder Support was designed by a doctor of physical therapy for postsurgical rehabilitation, injury recovery, people with arthritis, and athletes. By elevating and decompressing the shoulder joint, it counteracts gravity and the weight of the arm, to help decrease pain and soreness. It can be utilized when the patient is sleeping, driving, and performing the activities of daily life. Learn more » |
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Visual Impairment a Risk Factor for Dementia
A study of 3,038 people 65 and older found that visual impairment, because it leads to social isolation and reduced cognitive stimulation, is a risk factor for dementia. The good news, reported by The Washington Post, is that those whose vision is restored by cataract surgery are nearly 30% less likely to get dementia than are those who do not have the surgery.
Why Your Patients May Not Need Bone or Joint Surgery
According to British researchers, while surgery is superior to other treatments for carpal tunnel syndrome and total knee replacement, for six other surgeries commonly performed, the randomized trials showed no advantage to nonsurgical approaches. As The New York Times reports, the surgeries aren’t necessarily ineffective, but simply not superior, suggesting that it’s reasonable for many patients to choose nonsurgical options.
Exercise Protects Aging Synapses
Adding to the many reasons your older patients benefit from exercise is a UC San Francisco study indicating that activity boosts connections between neurons to enhance cognition. The study, the first demonstrating this protecting of aging synapses in humans, was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
The Burden of Omicron
The Omicron mutation has driven up hospitalizations at an alarming rate—one that, according to Ed Yong, who’s been covering the virus for The Atlantic throughout the pandemic—is crumbling the health care system. He tallies the toll and the present and future consequences. “People who would’ve been fine will get sicker,” he observes. “Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States.” |
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