Perioperative Opioids Refills in Tissue Expander Based Breast Reconstruction: Patient Risk Factors and Prescriber Trends
Franca Kraenzlin, Medical Doctor, Halley Darrach, BA, Pragna Shetty, BS MPH, Justin Sacks, MD.
Johns Hopkins, baltimore, MD, USA.
BACKGROUND: Tissue expander based breast reconstruction (TE-BR) is one of the most common procedures performed by board-certified plastic surgeons a year. Despite this, there is no literature on what constitutes an adequate post-operative pain regimen. Death by a physician’s opioid prescription remains a prevalent problem, with roughly 17,000 people dying in 2017 alone. In this study, we aimed to develop guidance on what constitutes an adequate pain regimen for patients undergoing TE-BR.
METHODS: An IRB approved retrospective review of all adult post-mastectomy patients receiving TEs was completed for a 16 month period at one academic medical center (n=229).
RESULTS: A 64.0% decline in oral morphine equivalents (OME) prescribed at discharge was observed over time (R2 = 0.77, p<0.01). A reduction in refill prescriptions numbers (74.1% reduction, R2 = 0.26, p<0.01) and average refill OMEs (63.5% reduction, R2 = 0.3, p=0.03) was also observed. Restrictive opioid regimens (≤150 OMEs) were not associated with an increased likelihood of requiring a refill (11.3%). Multimodal pain control did not reduce the odds of an opioid refill.
Opioid overprescription is a systemic problem in surgery. A significant reduction in the number of discharge OMEs prescribed and a reduction in opioid refills were observed. Participants receiving restrictive amounts of discharge opioids (≤150 OMEs) had the lowest rate of refills. Multimodal pain control was not associated with a reduced odds of receiving a refill. Prospective studies are needed to establish adequate discharge OME amounts and to understand how the amount of OMEs written affects pain perception.
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