Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

Justin Z. Lee, Ahmed K. Pasha, Amy E. Glasgow, Elizabeth B. Habermann, Fred M. Kusumoto, Christopher J. McLeod, Vasudha Goel, Dan Sorajja, Komandoor Srivathsan, Win Kuang Shen, Malini Madhavan, Abhishek J. Deshmukh, Yong Mei Cha, Paul A. Friedman, Samuel J. Asirvatham, Siva K. Mulpuru

Research output: Contribution to journalArticle

Abstract

Background: Prescription opioids are a major cause of the opioid epidemic. Despite the invasive nature of cardiac implantable electronic device (CIED) procedures, data on opioid prescription patterns after CIED procedures are lacking. Objective: The purpose of this study was to assess opioid prescribing patterns and the rates of new opioid refills (refills in previously opioid naïve patients) among patients undergoing CIED procedures. Methods: We performed a retrospective analysis of all patients undergoing CIED procedures from January 1, 2010, to March 30, 2018, at the Mayo Clinic (Minnesota, Arizona, and Florida). Procedures were categorized into new implant, generator change, device upgrade, lead revision or replacement, and subcutaneous implantable cardiac defibrillator (S-ICD) procedures. The rates of postoperative opioid prescription and new opioid refills were analyzed. Wilcoxon rank sum and χ2 tests assessed variations. Results: A total of 16,517 patients (mean age 70 ± 15; 36% female) underwent CIED procedures. Opioids were prescribed to 20.2% of the patients, among whom 80% were opioid naïve. Among opioid naïve patients who received opioids, 9.4% (95% confidence interval [CI] 8.3%–10.5%) had subsequent opioid refills. The percentage of patients who received more than 200 oral morphine equivalents of prescription was 38.8% (95% CI 37.2%–40.5%). Temporal trends revealed increasing rates of any opioid prescription, peaking in 2015 at 25.9%, with subsequent downtrend to 14.6% in 2018 (P <.001). Conclusion: Postoperative opioid prescription rate after CIED procedures was 20.2%, with most patients being opioid naïve. Among opioid naïve patients who received opioids, 9.4% had subsequent opioid refills. This finding suggests that perioperative pain management in CIED procedures warrants meticulous attention.

Original languageEnglish (US)
Pages (from-to)1841-1848
Number of pages8
JournalHeart rhythm
Volume16
Issue number12
DOIs
StatePublished - Dec 2019

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Opioid Analgesics
Prescriptions
Equipment and Supplies
Confidence Intervals
Implantable Defibrillators
Pain Management
Nonparametric Statistics
Morphine

Keywords

  • Cardiac implantable electronic devices
  • Opioid prescription
  • Pacemaker
  • Postoperative pain
  • Quality improvement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures. / Lee, Justin Z.; Pasha, Ahmed K.; Glasgow, Amy E.; Habermann, Elizabeth B.; Kusumoto, Fred M.; McLeod, Christopher J.; Goel, Vasudha; Sorajja, Dan; Srivathsan, Komandoor; Shen, Win Kuang; Madhavan, Malini; Deshmukh, Abhishek J.; Cha, Yong Mei; Friedman, Paul A.; Asirvatham, Samuel J.; Mulpuru, Siva K.

In: Heart rhythm, Vol. 16, No. 12, 12.2019, p. 1841-1848.

Research output: Contribution to journalArticle

Lee, Justin Z. ; Pasha, Ahmed K. ; Glasgow, Amy E. ; Habermann, Elizabeth B. ; Kusumoto, Fred M. ; McLeod, Christopher J. ; Goel, Vasudha ; Sorajja, Dan ; Srivathsan, Komandoor ; Shen, Win Kuang ; Madhavan, Malini ; Deshmukh, Abhishek J. ; Cha, Yong Mei ; Friedman, Paul A. ; Asirvatham, Samuel J. ; Mulpuru, Siva K. / Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures. In: Heart rhythm. 2019 ; Vol. 16, No. 12. pp. 1841-1848.
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title = "Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures",
abstract = "Background: Prescription opioids are a major cause of the opioid epidemic. Despite the invasive nature of cardiac implantable electronic device (CIED) procedures, data on opioid prescription patterns after CIED procedures are lacking. Objective: The purpose of this study was to assess opioid prescribing patterns and the rates of new opioid refills (refills in previously opioid na{\"i}ve patients) among patients undergoing CIED procedures. Methods: We performed a retrospective analysis of all patients undergoing CIED procedures from January 1, 2010, to March 30, 2018, at the Mayo Clinic (Minnesota, Arizona, and Florida). Procedures were categorized into new implant, generator change, device upgrade, lead revision or replacement, and subcutaneous implantable cardiac defibrillator (S-ICD) procedures. The rates of postoperative opioid prescription and new opioid refills were analyzed. Wilcoxon rank sum and χ2 tests assessed variations. Results: A total of 16,517 patients (mean age 70 ± 15; 36{\%} female) underwent CIED procedures. Opioids were prescribed to 20.2{\%} of the patients, among whom 80{\%} were opioid na{\"i}ve. Among opioid na{\"i}ve patients who received opioids, 9.4{\%} (95{\%} confidence interval [CI] 8.3{\%}–10.5{\%}) had subsequent opioid refills. The percentage of patients who received more than 200 oral morphine equivalents of prescription was 38.8{\%} (95{\%} CI 37.2{\%}–40.5{\%}). Temporal trends revealed increasing rates of any opioid prescription, peaking in 2015 at 25.9{\%}, with subsequent downtrend to 14.6{\%} in 2018 (P <.001). Conclusion: Postoperative opioid prescription rate after CIED procedures was 20.2{\%}, with most patients being opioid na{\"i}ve. Among opioid na{\"i}ve patients who received opioids, 9.4{\%} had subsequent opioid refills. This finding suggests that perioperative pain management in CIED procedures warrants meticulous attention.",
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T1 - Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

AU - Lee, Justin Z.

AU - Pasha, Ahmed K.

AU - Glasgow, Amy E.

AU - Habermann, Elizabeth B.

AU - Kusumoto, Fred M.

AU - McLeod, Christopher J.

AU - Goel, Vasudha

AU - Sorajja, Dan

AU - Srivathsan, Komandoor

AU - Shen, Win Kuang

AU - Madhavan, Malini

AU - Deshmukh, Abhishek J.

AU - Cha, Yong Mei

AU - Friedman, Paul A.

AU - Asirvatham, Samuel J.

AU - Mulpuru, Siva K.

PY - 2019/12

Y1 - 2019/12

N2 - Background: Prescription opioids are a major cause of the opioid epidemic. Despite the invasive nature of cardiac implantable electronic device (CIED) procedures, data on opioid prescription patterns after CIED procedures are lacking. Objective: The purpose of this study was to assess opioid prescribing patterns and the rates of new opioid refills (refills in previously opioid naïve patients) among patients undergoing CIED procedures. Methods: We performed a retrospective analysis of all patients undergoing CIED procedures from January 1, 2010, to March 30, 2018, at the Mayo Clinic (Minnesota, Arizona, and Florida). Procedures were categorized into new implant, generator change, device upgrade, lead revision or replacement, and subcutaneous implantable cardiac defibrillator (S-ICD) procedures. The rates of postoperative opioid prescription and new opioid refills were analyzed. Wilcoxon rank sum and χ2 tests assessed variations. Results: A total of 16,517 patients (mean age 70 ± 15; 36% female) underwent CIED procedures. Opioids were prescribed to 20.2% of the patients, among whom 80% were opioid naïve. Among opioid naïve patients who received opioids, 9.4% (95% confidence interval [CI] 8.3%–10.5%) had subsequent opioid refills. The percentage of patients who received more than 200 oral morphine equivalents of prescription was 38.8% (95% CI 37.2%–40.5%). Temporal trends revealed increasing rates of any opioid prescription, peaking in 2015 at 25.9%, with subsequent downtrend to 14.6% in 2018 (P <.001). Conclusion: Postoperative opioid prescription rate after CIED procedures was 20.2%, with most patients being opioid naïve. Among opioid naïve patients who received opioids, 9.4% had subsequent opioid refills. This finding suggests that perioperative pain management in CIED procedures warrants meticulous attention.

AB - Background: Prescription opioids are a major cause of the opioid epidemic. Despite the invasive nature of cardiac implantable electronic device (CIED) procedures, data on opioid prescription patterns after CIED procedures are lacking. Objective: The purpose of this study was to assess opioid prescribing patterns and the rates of new opioid refills (refills in previously opioid naïve patients) among patients undergoing CIED procedures. Methods: We performed a retrospective analysis of all patients undergoing CIED procedures from January 1, 2010, to March 30, 2018, at the Mayo Clinic (Minnesota, Arizona, and Florida). Procedures were categorized into new implant, generator change, device upgrade, lead revision or replacement, and subcutaneous implantable cardiac defibrillator (S-ICD) procedures. The rates of postoperative opioid prescription and new opioid refills were analyzed. Wilcoxon rank sum and χ2 tests assessed variations. Results: A total of 16,517 patients (mean age 70 ± 15; 36% female) underwent CIED procedures. Opioids were prescribed to 20.2% of the patients, among whom 80% were opioid naïve. Among opioid naïve patients who received opioids, 9.4% (95% confidence interval [CI] 8.3%–10.5%) had subsequent opioid refills. The percentage of patients who received more than 200 oral morphine equivalents of prescription was 38.8% (95% CI 37.2%–40.5%). Temporal trends revealed increasing rates of any opioid prescription, peaking in 2015 at 25.9%, with subsequent downtrend to 14.6% in 2018 (P <.001). Conclusion: Postoperative opioid prescription rate after CIED procedures was 20.2%, with most patients being opioid naïve. Among opioid naïve patients who received opioids, 9.4% had subsequent opioid refills. This finding suggests that perioperative pain management in CIED procedures warrants meticulous attention.

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KW - Opioid prescription

KW - Pacemaker

KW - Postoperative pain

KW - Quality improvement

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