Navigating the Pain Crisis: Opioid Reduction in Opioid-Naïve Patients after Cardiac Surgery

Purpose: To develop a standard multidisciplinary approach that was utilized across the care continuum to reduce opioid prescription use in opioid naïve cardiac surgery patients.

Relevance: The United States is currently experiencing an opioid misuse epidemic across all disciplines in health care. An estimated 21 to 29 percent of patients who use opioids chronically misuse them, and 8-12 percent progress to develop an opioid use disorder. Addressing this crisis has become imperative in an acute post-operative period to prevent prolonged exposure in opioid naïve patients, as this population has an associated increased dependence risk with continued use.

Methods: In investigating our opioid use, we identified six root causes contributing to our overuse: lack of staff buy in, lack of preoperative education, no standard opioid regimen, a lack of caregiver awareness, unclear alternative pain therapies, and an absence of post-operative pain follow-up.

To address these barriers, we established multidisciplinary opioid reduction strategies, which included: 1) standard opioid and non-pharmacologic regimens, 2) standardized pre-operative education, 3) incorporated family members, 4) empowered patients and family members to wean their opioid therapy, 5) established realistic pain expectations, and 6) emphasized non-pharmacologic interventions.

Evaluation/outcome: Through our interventions across the care continuum, there has been a reduction in average pills prescribed from 65 to 29 pills, or by 44%, in one year. Prior to our interventions, our department prescribed an average of 62.9 tablets of Norco 5/325 mg, 68.1 tablets of oxycodone 5 mg, and 58.9 tablets of tramadol 50 mg. Following our interventions, our department prescribed an average of 31.5 tablets of Norco, 30.8 tablets of oxycodone, and 18.6 tablets of tramadol. This reduction was clinically significant with an associated p value of 2.77E-31. This decreased use showed no variance to our baseline length of stay, postoperative visit utilization, or patient satisfaction.

Conclusions: Through a multidisciplinary approach, we have the potential to significantly decrease perioperative and postoperative opioid use. A standardized approach across the continuum can decrease the exposure of vulnerable opioid naïve patients without affecting the quality or satisfaction with care.