Thoracic Surgery

OPEN’s Opioid Prescribing Recommendations are designed to spark meaningful conversations between patients and providers, so every pain management plan is tailored to the individual. These recommendations are rooted in research, patient-reported outcomes, and expert consensus. They are intended for patients who haven’t used opioids before surgery. Explore OPEN’s evidence-based recommendations for safer prescribing after thoracic surgery below.

Learn more at michigan-open.org/prescribing-recommendations/.

Oxycodone
5mg Tabs

Lung Cancer Resection - Minimally Invasive

0-15

SUPPORTING LITERATURE

Mondoñedo et al. 2023 (Level 3 evidence)

DOI: https://dx.doi.org/10.21037/jtd-22-1621
Patient-reported outcomes data collected at 30-day clinic follow-up appointment after lung cancer resection (n=204 total survey respondents, n=171 minimally invasive operations).
Post-operative LOS = 3.7±2.8 days.
Patient-reported opioid use significantly less than pills prescribed at discharge (8.2±13.0 vs. 20.5±13.1 pills).
No opioid use after discharge reported by 43.7% of patients.
Lower post-discharge opioid prescription recommended for patients requiring zero opioids the day prior to discharge (prescribe 0 – 5 pills).

Lung Cancer Resection - Open

0-20

SUPPORTING LITERATURE

Mondoñedo et al. 2023 (Level 3 evidence)

DOI: https://dx.doi.org/10.21037/jtd-22-1621
Patient-reported outcomes data collected at 30-day clinic follow-up appointment after lung cancer resection (n=204 total survey respondents, n=20 open thoracotomy).
Post-operative LOS = 3.7±2.8 days.
Patient-reported opioid use significantly less than pills prescribed at discharge (8.2±13.0 vs. 20.5±13.1 pills).
Higher proportion of open thoracotomy patients used 11 to 20 pills.
Lower post-discharge opioid prescription recommended for patients requiring zero opioids the day prior to discharge (prescribe 0 – 5 pills).

Cardiac Survery via Median Sternotomy

0-25

SUPPORTING LITERATURE

Brescia et al. 2020 (Level 1 evidence)

DOI: https://doi.org/10.1016/j.athoracsur.2020.11.015
Analyzed data from 1495 patients undergoing primary cardiac surgery via median sternotomy at 10 hospitals from January-December 2019.
Median prescription size decreased from 20 pills to 12 pills after recommendation.
Patients using 0 pills before discharge were prescribed 0 pills.
Patients using 1 to 3 pills before discharge were prescribed 20 pills but used only 7.
Patients using 4 or more pills before discharge were prescribed 32 pills but used 24.

Wagner et al. 2021 (Level 2 evidence)

DOI: https://doi.org/10.1016/j.athoracsur.2021.10.005
Analyzed data from 1924 patients undergoing coronary artery bypass grafting and/or valve surgery through a sternotomy at 10 institutions from January-December 2019.
47% of patients did not take any opioids on day before discharge and among these patients, 54% did not receive an opioid prescription at time of discharge.
Patients who received an opioid prescription at discharge used 2.4 ± 3.0 pills on day before discharge while those that did not receive a prescription took 0.2 ± 0.6 pills.

OPIOID PRESCRIBING

When an opioid is needed after surgery, use the OPEN prescribing recommendations as the foundation for a shared decision-making conversation with the patient to determine the best prescription size.

It’s important to note that these are not rigid rules that must be adhered to, but rather recommendations. Starting form a standardized approach and then allowing for individualization helps promote both equity and patient-centeredness.

Determine the opioid prescribing range based on:
- Type of procedure
- Additional procedures performed
With the patient, determine the best prescription size within the appropriate range
- Assess for individual risk factors
- Consider patient preferences and other non-opioid strategies utilized
- Pain management at the time of discharge:
  - Pain scores in 24 hours prior to discharge
  - Medication use in 24 hours prior to discharge
  - Timing of discharge