Heart, Lung and Circulation

Opioid Prescription After Cardiac Surgery

Published:October 14, 2021DOI:


      To characterise short-term and long-term opioid prescription patterns after cardiac surgery.

      Design, Setting and Participants

      We obtained data from a single Australian tertiary hospital from November 2012 to July 2019 and included 2,205 patients who underwent a primary cardiac surgical procedure.

      Main Outcome and Measures

      The primary outcome was the dose of opioids at hospital discharge. Secondary outcomes included factors associated with high dose opioid prescriptions and persistent opioids use after cardiac surgery.


      Overall, 76.4% of study patients were prescribed opioids at hospital discharge, with a median discharge prescription of 150 mg oral morphine equivalents. Moreover, 52.8% of discharge opioid prescriptions were as slow-release formulations and 60.0% of all discharge prescriptions were for patients who had received no opioids the day before discharge. In the subset of our patients with long-term data, 14.0% were still receiving opioids at 3–12 months after cardiac surgery.


      In cardiac surgical patients, opioid prescriptions at discharge were common, most were at higher than recommended doses and more than half were slow-release formulations. Such prescription was associated with one in seven patients continuing to receive opioids 3–12 months after surgery.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shipton E.A.
        • Shipton E.E.
        • Shipton A.J.
        A Review of the opioid epidemic: what do we do about it?.
        Pain Ther. 2018; 7: 23-36
        • Lalic S.
        • Ilomäki J.
        • Bell J.S.
        • Korhonen M.J.
        • Gisev N.
        Prevalence and incidence of prescription opioid analgesic use in Australia.
        Br J Clin Pharmacol. 2019; 85: 202-215
        • Roxburgh A.
        • Hall W.D.
        • Dobbins T.
        • Gisev N.
        • Burns L.
        • Pearson S.
        • et al.
        Trends in heroin and pharmaceutical opioid overdose deaths in Australia.
        Drug Alcohol Depend. 2017; 179: 291-298
        • Bicket M.C.
        • Long J.J.
        • Pronovost P.J.
        • Alexander G.C.
        • Wu C.L.
        Prescription opioid analgesics commonly unused after surgery: a systematic review.
        JAMA Surg. 2017; 152: 1066-1071
        • Allen M.L.
        • Kim C.C.
        • Braat S.
        • Jones K.
        • Winter N.
        • Hucker T.R.
        • et al.
        Post-discharge opioid use and handling in surgical patients: a multicentre prospective cohort study.
        Anaesth Intensive Care. 2020; 48: 36-42
        • Clarke H.
        • Soneji N.
        • Ko D.T.
        • Yun L.
        • Wijeysundera D.N.
        Rates and risk factors for prolonged opioid use after major surgery: population based cohort study.
        BMJ. 2014; 348: 1-10
        • Sun E.C.
        • Darnall B.D.
        • Baker L.C.
        • MacKey S.
        Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period.
        JAMA Intern Med. 2016; 176: 1286-1293
        • Brummett C.M.
        • Waljee J.F.
        • Goesling J.
        • Moser S.
        • Lin P.
        • Englesbe M.J.
        • et al.
        New persistent opioid use after minor and major surgical procedures in us adults.
        JAMA Surg. 2017; 152
        • Stark N.
        • Kerr S.
        • Stevens J.
        Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study.
        Anaesth Intensive Care. 2017; 45: 700-706
        • Brown C.R.
        • Brown C.R.
        • Chen Z.
        • Khurshan F.
        • Groeneveld P.W.
        • Groeneveld P.W.
        • et al.
        Development of persistent opioid use after cardiac surgery.
        JAMA Cardiol. 2020; : 1-8
        • Hirji S.A.
        • Landino S.
        • Cote C.
        • Lee J.
        • Orhurhu V.
        • Shah R.M.
        • et al.
        Chronic opioid use after coronary bypass surgery.
        J Card Surg. 2019; 34: 67-73
        • Clement K.C.
        • Canner J.K.
        • Lawton J.S.
        • Whitman G.J.R.
        • Grant M.C.
        • Sussman M.S.
        Predictors of new persistent opioid use after coronary artery bypass grafting.
        J Thorac Cardiovasc Surg. 2020;
        • Australian and New Zealand College of Anaesthetists
        Statement on the Use of Slow-Release Opioid Preparations in the Treatment of Acute Pain.
        ANZCA Bull. 2018; 01: 15-16
        • Australian Government Therapeutic Goods Administration
        Prescription opioids: What changes are being made and why 2020.
        • ANZSCTS National Cardiac Surgery Database
        Data Definitions Manual Version 4 2017.
        • Faculty of Pain Medicine ANZCA
        Opioid Calculator 2019.
        Date accessed: November 14, 2020
        • Zhao J.
        • Peters L.
        • Gelzinnis S.
        • Carroll R.
        • Nolan J.
        • Di Sano S.
        • et al.
        Post-discharge opioid prescribing after laparoscopic appendicectomy and cholecystectomy.
        ANZ J Surg. 2020; 90: 1014-1018
        • Roughead E.E.
        • Lim R.
        • Ramsay E.
        • Moffat A.K.
        • Pratt N.L.
        Persistence with opioids post discharge from hospitalisation for surgery in Australian adults: a retrospective cohort study.
        BMJ Open. 2019; 9: 1-6
        • Macintyre P.E.
        • Huxtable C.A.
        • Flint S.L.P.
        • Dobbin M.D.H.
        Costs and consequences: a review of discharge opioid prescribing for ongoing management of acute pain.
        Anaesth Intensive Care. 2014; 42: 558-574
        • Kardell L.D.
        • Hilmer S.N.
        • Crane J.A.
        • MacPherson R.
        • Kim T.Y.
        • Lisa)
        • Gnjidic D.
        Investigation of opioid prescribing in the postoperative setting among opioid-naïve surgical patients: a 6-month observational study.
        J Pharm Pract Res. 2019; 49: 58-61
      1. The Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Annual Report 2018. ANZSCTS, 2018
        • Overton H.N.
        • Hanna M.N.
        • Bruhn W.E.
        • Hutfless S.
        • Bicket M.C.
        • Makary M.A.
        • et al.
        Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus.
        J Am Coll Surg. 2018; 227: 411-418
        • Shah A.
        • Hayes C.J.
        • Martin B.C.
        Morbidity and mortality weekly report characteristics of initial prescription episodes and likelihood of long-term opioid use-United States, 2006-2015.
        Morb Mortal Wkly Rep. 2017; 66: 265-269
        • Tan A.C.H.
        • Bugeja B.A.
        • Begley D.A.
        • Stevens J.A.
        • Khor K.E.
        • Penm J.
        Postoperative use of slow-release opioids: the impact of the Australian and New Zealand College of Anaesthetists/Faculty of Pain Medicine position statement on clinical practice.
        Anaesth Intensive Care. 2020; 48: 444-453
        • Awadalla R.
        • Liu S.
        • Kemp-Casey A.
        • Gnjidic D.
        • Patanwala A.
        • Stevens J.
        • et al.
        Impact of an Australian/New Zealand organisational position statement on extended-release opioid prescribing among surgical inpatients: a dual centre before-and-after study.
        Anaesthesia. 2021; : 1-9
        • Hopkins R.E.
        • Bui T.
        • Konstantatos A.H.
        • Arnold C.
        • Magliano D.J.
        • Liew D.
        • et al.
        Educating junior doctors and pharmacists to reduce discharge prescribing of opioids for surgical patients: a cluster randomised controlled trial.
        Med J Aust. 2020; 213: 417-423