As surgeons, we need to … take action directly addressing the issue of postthoracotomy narcotic usage.
STS recognizes its role and that of its members in confronting this ongoing epidemic. Our first action is to better understand the current state of practice and, therefore, the Society has undertaken an electronic member survey requesting specific information regarding the routine practice of opioid administration and prescription following cardiothoracic surgery. Information regarding standard dosage, number of pills, and duration of treatment has been requested both from surgeons and associated providers who have been asked to participate (physician assistants, advanced practice nurses, anesthesiologists). This information will help form the foundation for the Society’s response to this nationwide problem. It is hoped that the results of this survey will help STS identify best practices and then issue expert clinical opinion regarding optimal perioperative utilization of both opioid medication and nonnarcotic pain control methods and medications.
In addition, the Society will undertake ongoing education initiatives to help guide the membership in future practice. This will include emphasis of ERATS (Enhanced Recovery After Thoracic Surgery) protocols, a topic that was highlighted at the recent Fort Lauderdale meeting (see page 8 for information on how to access a related video roundtable and podcast). ERATS also will be addressed specifically at the upcoming STS Critical Care Conference in October, and it is expected that next year’s Annual Meeting in San Diego will highlight the issue of perioperative pain management and responsible perioperative opioid utilization in breakout sessions.
It is unrealistic to expect that cardiothoracic surgeons will be able to forgo narcotic medication completely given the nature of our operative incisions. However, both you the members and our patients can and should expect the Society to help guide practitioners in the measured and judicious approach to opioid usage in both inpatient and outpatient arenas. Such an approach will help minimize the risk of addiction for our patients and help address the ongoing epidemic.
It seems that this scourge caught most of America flat-footed in 2017, and our specialty was no exception. But now I believe we all recognize that the problem exists and it is one in which cardiothoracic surgeons have unwittingly played a role, however unintended. Yes, we have a problem, but now we pledge that—together—we will become part of the solution.