Northeastern Society of Plastic Surgeons

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Just Say Yes: Changing Opioid Prescribing Algorithms in Plastic Surgery
Shayan M. Sarrami*, Nia Buckner, Kelly Murphy, Isaac James, Casey Zhang, Elizabeth Moroni, Carolyn De La Cruz
Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Introduction
Changing opiate prescribing practices in surgical fields without guidelines or standardizations can be a daunting task. An encouraging amount of literature has shown the benefits of reducing opioid use, but many plastic surgeons hesitate to initiate this directive. We present a practice modification designed to reduce the number of opiates prescribed and highlight the steps needed to implement a new prescribing algorithm.

Methods
In October of 2023 we implemented a new opiate algorithm for patients undergoing breast surgery. In the pre-intervention group, patients received 30 pills of postoperative opiates and recorded their consumption. Following the intervention, patients were given a maximum of 10 pills. To guide this new prescribing practice, we relied on pill consumption analysis from our pre-intervention group. In each cohort, data was collected on postoperative analgesic use per procedure.

Results
41 survey responses were included in our pre-intervention cohort and 10 in our post-intervention cohort. A median of 5.5 pills was consumed by patients who received implant or tissue expanders, 4.75 pills for pedicled flaps, 12 pills for fat grafting, 5 pills for breast reduction, and 12.5 pills for gender affirming mastectomies. Before and after the intervention, median opiate consumption was similar at 6 pills and 5.5 pills, respectively. Patients in both cohorts would consume pills for a median of 4 days. In the pre-intervention group, patients had a median of 24 unused pills. This was significantly reduced to 0.5 unused pills in the post-intervention cohort (p<0.000). Refill requirements and analgesic use by the two groups was not significantly different (p=0.063 & p=0.545).

Conclusion
We have outlined a pathway for updating opioid prescribing algorithms in plastic surgery. Our opiate intervention significantly diminished opiate excess, reducing the risk for abuse. With growing research demonstrating the benefits of regulating prescriptions, and the best ways to implement change, surgeons can feel confident to just say yes to this meaningful reform.


Postoperative analgesic consumption data before and after implementing an opioid intervention.
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