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Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction

Marcusa, Daniel P. B.A.; Mann, Rachel A. B.A.; Cron, David C. B.S.; Fillinger, Brooklyn R. B.S., B.A.; Rzepecki, Alexandra K. B.S.; Kozlow, Jeffrey H. M.D., M.S.; Momoh, Adeyiza M.D.; Englesbe, Michael M.D.; Brummett, Chad M.D.; Waljee, Jennifer F. M.D., M.S.

Plastic and Reconstructive Surgery: December 2017 - Volume 140 - Issue 6 - p 1081–1090
doi: 10.1097/PRS.0000000000003832
Breast: Original Article
Patient Safety CME
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Background: Cancer patients may be particularly vulnerable to the deleterious effects of prolonged opioid use. The authors explored the factors that influence postoperative opioid prescription fills among women following postmastectomy reconstruction.

Methods: Using the Truven Health MarketScan Research Databases, the authors identified a cohort of 4113 opioid-naive patients undergoing mastectomy and immediate breast reconstruction between January of 2010 and August of 2014. Outcomes included average daily oral morphine equivalents and the incidence of prolonged opioid fills (between 90 and 120 days after surgery). Using multivariable regression, the authors examined the effect of patient demographic characteristics, reconstructive technique, comorbid medical and psychiatric conditions, and postoperative complications on outcome variables.

Results: In this cohort, 90 percent of patients filled opioid prescriptions perioperatively, and 10 percent continued to fill prescriptions beyond 3 months after surgery. Patients with depression were more likely to fill prescriptions of higher average daily oral morphine equivalents (74.2 mg versus 58.3 mg; p < 0.01), and patients with anxiety were more likely to fill opioids for prolonged periods (13.4 percent versus 9.1 percent; p < 0.01). Patients undergoing autologous free flap reconstruction were less likely to fill prescriptions for a prolonged period following surgery (5.9 percent versus 10.2 percent; p < 0.001).

Conclusions: Prescription opioid fills are common following breast reconstruction, and 10 percent of all patients continue to fill opioid prescriptions beyond 3 months after surgery. Prolonged fills are influenced by both patient factors and surgical procedure, and attention should be directed toward identifying opioid alternatives when possible.

CLINCAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Supplemental Digital Content is available in the text.

Ann Arbor, Mich.

From the University of Michigan Medical School, the Sections of Plastic Surgery and Transplantation Surgery, and the Department of Anesthesiology, University of Michigan.

Received for publication February 3, 2017; accepted June 29, 2017.

Presented at 11th Annual Academic Surgical Congress, in Jacksonville, Florida, February 2 through 4, 2016.

By reading this article, you are entitled to claim one (1) hour of AMA PRA Category 2 CME & Patient Safety Credit. ASPS members can claim this credit by logging in to Plastic-Surgery.org Dashboard, clicking “Submit CME,” and completing the form.

The authors listed first and second are co–first authors.

Disclosure: Dr. Waljee receives research funding from the Agency for Healthcare Research and Quality (K08 1K08HS023313-01), the American College of Surgeons, and the American Foundation for Surgery of the Hand; and serves as an unpaid consultant for 3M Health Information systems. The authors have no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Videos” tab to watch.” On the iPad, tap on the Hot Topics icon.

Jennifer F. Waljee, M.D., M.S., 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-0340, filip@med.umich.edu

©2017American Society of Plastic Surgeons