RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0042-1744419
Prolonged Opioid Use Among Opioid-Naive Women Undergoing Breast Reconstructive Surgery
![](https://www.thieme-connect.de/media/10.1055-s-00051611/202203/lookinside/thumbnails/10-1055-s-0042-1744419_21165-1.jpg)
Abstract
Background Patients that undergo mastectomy for breast cancer with reconstruction may be prone to prolonged opioid use. As risk factors are not well-established, this article sought to better understand the risk factors that may be associated with this.
Methods Patients that underwent breast reconstruction between 2010 and 2018 were identified in PearlDiver, a national insurance claims database. Patient demographics and comorbidities were elucidated, and various complications were then identified. Descriptive statistics as well as a multivariate analysis was used to evaluate the association of risk factors and complications.
Results Breast reconstruction patients of 24,765 were identified from this database. Obesity, tobacco use, benzodiazepine use, and anticonvulsant use were all associated with prolonged opioid prescriptions greater than 90 days after both alloplastic and autologous reconstruction.
Conclusion Prolonged opioid use continues to remain a topic of concern, and particularly in cancer patients that undergo breast reconstruction. Providers should be aware of potential risk factors for this to reduce this chance following breast reconstruction surgery.
Author Contributions
Conceptualization: A.R.S. and J.T.S. Data curation: A.R.S., J.T.S. Formal analysis: A.R.S., J.T.S. Methodology: J.T.S. Project administration: A.R.S. Visualization: A.R.S. and J.T.S. Writing - original draft: A.R.S. and L.F. Writing - review and editing: L.F., B.R.D.Jr, J.B., C.C., J.S.
Publikationsverlauf
Artikel online veröffentlicht:
27. Mai 2022
© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Centers for Disease Control and Prevention (CDC). Understanding the epidemic [Internet]. Atlanta, GA: CDC; c2020. Accessed March 19, 2021 at: https://www.cdc.gov/drugoverdose/epidemic/index.html
- 2 Roth RS, Qi J, Hamill JB. et al. Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction. Breast 2018; 37: 119-125
- 3 McGugin CJ, Coopey SB, Smith BL. et al. Enhanced recovery minimizes opioid use and hospital stay for patients undergoing mastectomy with reconstruction. Ann Surg Oncol 2019; 26 (11) 3464-3471
- 4 Woeste MR, Bhutiani N, Geller AE, Eldridge-Hindy H, McMasters KM, Ajkay N. Identifying factors predicting prolonged opioid use after mastectomy. Ann Surg Oncol 2020; 27 (04) 993-1001
- 5 Marcusa DP, Mann RA, Cron DC. et al. Prescription opioid use among opioid-naïve women undergoing immediate breast reconstruction. Plast Reconstr Surg 2017; 140 (06) 1081-1090
- 6 Hah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Analg 2017; 125 (05) 1733-1740
- 7 Azad AD, Bozkurt S, Wheeler AJ, Curtin C, Wagner TH, Hernandez-Boussard T. Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes. J Surg Oncol 2020; 122: 623-631
- 8 Chao LF, Patel KM, Chen SC. et al. Monitoring patient-centered outcomes through the progression of breast reconstruction: a multicentered prospective longitudinal evaluation. Breast Cancer Res Treat 2014; 146 (02) 299-308
- 9 Falk Dahl CA, Reinertsen KV, Nesvold IL, Fosså SD, Dahl AA. A study of body image in long-term breast cancer survivors. Cancer 2010; 116 (15) 3549-3557
- 10 Leroux TS, Saltzman BM, Sumner SA. et al. Elective shoulder surgery in the opioid naïve: rates of and risk factors for long-term postoperative opioid use. Am J Sports Med 2019; 47 (05) 1051-1056
- 11 Nayyar A, Strassle PD, Reddy KG. et al. Variations in the utilization of immediate post-mastectomy breast reconstruction. Am J Surg 2019; 218 (04) 712-715
- 12 Dwyer MK, Tumpowsky CM, Hiltz NL, Lee J, Healy WL, Bedair HS. Characterization of post-operative opioid use following total joint arthroplasty. J Arthroplasty 2018; 33 (03) 668-672
- 13 Murphy BL, Hanson KT, Hieken TJ, McLaughlin S, Gray RJ, Habermann EB. Patient-reported experience after outpatient breast surgery. Am J Surg 2019; 218 (01) 175-180
- 14 Shen C, Thornton JD, Gu D. et al. Prolonged opioid use after surgery for early-stage breast cancer. Oncologist 2020; 25 (10) e1574-e1582
- 15 Kendall MC, Castro Alves LJ. Prescription opioid use among opioid-naïve women undergoing immediate breast reconstruction. Plast Reconstr Surg 2018; 142 (04) 609e
- 16 Yoon AP, Qi J, Brown DL. et al. Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. Breast 2018; 37: 72-79
- 17 Gassman AA, Yoon AP, Maxhimer JB. et al. Comparison of postoperative pain control in autologous abdominal free flap versus implant-based breast reconstructions. Plast Reconstr Surg 2015; 135 (02) 356-367
- 18 Andersen KG, Duriaud HM, Jensen HE, Kroman N, Kehlet H. Predictive factors for the development of persistent pain after breast cancer surgery. Pain 2015; 156 (12) 2413-2422
- 19 Fassoulaki A, Melemeni A, Staikou C, Triga A, Sarantopoulos C. Acute postoperative pain predicts chronic pain and long-term analgesic requirements after breast surgery for cancer. Acta Anaesthesiol Belg 2008; 59 (04) 241-248
- 20 Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths: United States, 2010–2015. Morb Mortal Wkly Rep 2016; 65 (50-51): 1445-1452
- 21 Martin BC, Fan MY, Edlund MJ, Devries A, Braden JB, Sullivan MD. Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med 2011; 26 (12) 1450-1457
- 22 Johnson SP, Chung KC, Zhong L. et al. Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures. J Hand Surg Am 2016; 41 (10) 947-957
- 23 Stark N, Kerr S, Stevens J. Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study. Anaesth Intensive Care 2017; 45 (06) 700-706
- 24 Fahy AS, Jakub JW, Dy BM. et al. Paravertebral blocks in patients undergoing mastectomy with or without immediate reconstruction provides improved pain control and decreased postoperative nausea and vomiting. Ann Surg Oncol 2014; 21 (10) 3284-3289
- 25 Bourazani M, Papageorgiou E, Zarkadas G. et al. The role of muscle relaxants: spasmolytic (thiocochlicoside) in postoperative pain management after mastectomy and breast reconstruction. Asian Pac J Cancer Prev 2019; 20 (03) 743-749
- 26 Scarborough BM, Smith CB. Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin 2018; 68 (03) 182-196
- 27 Kulkarni AR, Pusic AL, Hamill JB. et al. Factors Associated with acute postoperative pain following breast reconstruction. JPRAS Open 2017; 11: 1-13
- 28 Campbell C. “Opioids in Plastic Surgery.” Lecture, Chicago, Illinois, September 29th, 2018