By Lisa Rapaport
(Reuters Health) – The proportion of U.S. heart surgery patients with opioid use disorders has surged in recent years, and a new study suggests addicts are much more likely to develop major surgery complications.
Prolonged opioid use is associated with an increased risk for cardiovascular problems like heart attacks and strokes as well as endocarditis, a life-threatening infection of the heart’s lining and valves, researchers note in JAMA Surgery.
For the study, they examined nationwide data on more than 5.7 million patients, including more than 11,000 with opioid use disorders, who had heart surgery between 1998 and 2013. During that time, the proportion of patients with opioid abuse problems surged eight-fold, from 0.06 percent to 0.54 percent.
While mortality rates were similar with and without opioid use disorder, people addicted to these drugs were more likely to have serious complications, longer hospital stays and higher costs.
“Patients should not be denied cardiac surgery in urgent situations as a result of opioid use, but they should be closely monitored after their operation for the development of complications, which they are at higher risk for,” said senior researcher Dr. Edward Soltesz, surgical director of the Kaufman Center for Heart Failure and Recovery at the Cleveland Clinic in Ohio.
“We see many opioid use disorder patients who end up in need of multiple operations due to continued use and each surgery becomes riskier,” Soltesz said by email.
Patients having heart surgery with opioid use disorder were almost two decades younger, on average, than patients without this problem: 48 years old versus 66. They were also more likely to be male, black or Hispanic, poor and uninsured or covered by Medicaid.
Overall, 3.1 percent of patients with opioid use disorder and 4 percent of patients without it died shortly after their surgery, a difference that was too small to rule out the possibility it was due to chance.
Among opioid addicts, however, 68 percent had major complications, compared with 59 percent of others in the study – a statistically meaningful difference.
Thirty percent of patients with opioid addiction needed blood transfusions, compared with 26 percent of other patients, and 18 percent of people with opioid use disorder needed breathing machines, compared with 16 percent of other patients.
The study wasn’t designed to prove whether opioid use disorders worsen surgical outcomes.
Even so, the results highlight the need to identify opioid use disorders before surgery because these drugs can damage the heart and blood vessels, said Dr. Gregg Fonarow of the David Geffen School of Medicine at University of California, Los Angeles.
“Opioids can slow the heart rate and lead to excess dilation of blood vessels producing potentially dangerous drops in blood pressure, and opioid use can suppress respiration,” Fonarow, who wasn’t involved in the study, said by email.
Opioids can also contribute to irregular heart rhythms and infection risks, he said.
“Those with opioid use disorder may also take other substances that also place them at higher risk for surgical complications,” Fonarow added. “The presence of an opioid use disorder alone should not be a deciding factor for not performing cardiovascular surgery, yet extra attention to reducing the risk of complications is needed.”
SOURCE: https://bit.ly/2AehUIk JAMA Surgery, online December 5, 2018.
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