Variations in Intraoperative Opioid Use in Cardiac Surgical Patients With Midline Sternotomy

Abstract

High-dose opioid use in cardiac anesthesia has been challenged due to its association with increased postoperative complications. We retrospectively compared postoperative opioid consumption in a cohort of adult cardiac surgery patients who received low, moderate, or high doses of intraoperative opioids. We also examined variability in intraoperative opioid use among cardiac anesthesiologists. Within our cohort, we categorized patients into “lower opioid recipients” (LOR), “mid opioid recipients” (MOR), or “higher opioid recipients” (HOR) based on the distribution of intraoperative opioids administered in morphine milligram equivalents (MME) within our cohort. After summarizing their demographics and clinical characteristics, we assessed the association between their intraoperative opioid dose group and our outcomes of interest including postoperative opioid consumption. A total of 6390 patients who underwent cardiac surgery between 2014 and 2022 met our inclusion criteria. Our multivariable models indicated that the HOR group was significantly associated with less postoperative opioid consumption relative to the LOR (MME: Mean Ratio (MR) = 0.51 (0.47, 0.56), P < 0.001; MME/kg: MR = 0.51 (0.48, 0.55), P < 0.001) and the MOR (MME: MR = 0.53 (0.50, 0.57), P < 0.001; MME/kg: MR = 0.55 (0.55 (0.51, 0.58), P < 0.001). Among patients undergoing elective adult cardiac surgery, higher doses of intraoperative opioids were associated with lower postoperative opioid consumption. Marked variability in opioid administration was observed among cardiac anesthesiologists, where higher intraoperative opioid use remains a common practice. This highlights the need for precise distinction between high and low dose opioid techniques.