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Opioid Prescribing and Consumption Patterns following Outpatient Plastic Surgery Procedures

Rose, Katherine R., M.D.; Christie, Brian M., M.D.; Block, Lisa M., M.D.; Rao, Venkat K., M.D., M.B.A.; Michelotti, Brett F., M.D.

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3 - p 929-938
doi: 10.1097/PRS.0000000000005351
Plastic Surgery Focus: Special Topics
Patient Safety CME
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Background: Opioid overprescribing is a nationwide problem contributing to the current epidemic. This study evaluated opioid consumption, physician prescribing, and patient satisfaction with pain control following outpatient plastic surgery procedures.

Methods: Patients completed a questionnaire during their first postoperative visit. The authors queried about procedure type, quantity of opioids prescribed and consumed, days to opioid cessation, prescription refills, pain scores, use of nonopioid analgesics, and satisfaction with pain control.

Results: One hundred seventy patients were included. On average, 26 tablets were prescribed and 13 were consumed. Eighty percent of patients stopped opioids by postoperative day 5. Patients rated their worst pain at 6.1 and follow-up pain at 1.9. Approximately 50 percent of patients consumed nonopioid analgesics. Ninety-six percent of patients were satisfied with their pain control. Similar findings were observed across procedure subcategories. The number of pills prescribed was not correlated with satisfaction but was predictive of worst pain level (p = 0.014). Reduction mammaplasty and abdominoplasty patients consumed the most opioids at 17 and 18.6 pills, respectively; however, first-stage alloplastic breast reconstruction had the largest percentage of patients consuming opioids at the time of follow-up (25 percent) and requiring refills (7 percent). Patients who underwent revision of their reconstructed breast reported the earliest opioid cessation, rated their pain the lowest, and were prescribed the most excess tablets.

Conclusions: Plastic surgeons are prescribing almost double the amount of opioids consumed by patients after outpatient plastic surgery procedures. The results of this study may help guide prescribing practices.

Patient Safety CME.

Madison, Wis.

From the Division of Plastic and Reconstructive Surgery, University of Wisconsin.

Received for publication February 13, 2018; accepted August 2, 2018.

Presented at the Midwestern Association of Plastic Surgeons Annual Meeting, in Chicago, Illinois, April 14, 2018; the Wisconsin Society of Plastic Surgery Annual Conference, in Milwaukee, Wisconsin, April 20, 2018; and the 63rd Annual Meeting of the Plastic Surgery Research Council, in Birmingham, Alabama, May 17 through 20, 2018.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

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

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

Brett F. Michelotti, M.D., 600 Highland Avenue, CSC G5/358, Madison, Wis. 53792,, Instagram: @uwiscplasticsurgery, Twitter: @WiscPlasticSurg

Copyright © 2019 by the American Society of Plastic Surgeons