Plastic Surgery Research Council

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Discrepancies In Opioid Prescription And Utilization Following Breast Reduction
Nick Wingate, MD, Mark Balceniuk, MD, Alap Patel, BA, Jose Guilherme Christiano, MD.
University of Rochester Medical Center, Rochester, NY, USA.

PURPOSE:
To examine opioid prescribing patterns after reduction mammoplasty and to assess percentage of pills that are actually consumed. Background: Prescription opioids are a major contributor to the opioid epidemic. Data to inform surgeons regarding inpatient pain control protocols are improving, but data describing the appropriate outpatient opioid regimen is lacking. METHODS: We evaluated 247 cases of reduction mammoplasty performed from 6/2015 to 2/2018 at a single institution with four surgeons. Postoperative opioid prescriptions, prescribers, and refill data were tabulated. A phone survey was conducted to determine the percentage of opioid pills consumed. RESULTS:
There was a wide variation in the number of opioid pills prescribed to patients undergoing reduction mammoplasty at a single institution. The mean number (and range) prescribed was 38 (10-60) pills. The mean (and range) of morphine equivalents prescribed was 230.5 (75-675). 78% of patients consumed 25% or less of the pills prescribed. 14% of patients took no narcotics or never filled their prescription. Approximately 15% of patients obtained refills. Average refill prescription was for 35 pills. There is a large variation in prescribing habits among providers for the same procedure. Only one of the 12 prescribing providers prescribed the same number of morphine equivalents routinely. We identified the number of pills that suffice the opioid needs of 80% of patients undergoing reduction mammoplasty to be 20 pills. Compared to the current average 38 pill prescription, this would be a 47% reduction of opioid pills prescribed. CONCLUSION:
We demonstrate wide variability of discharge opioid prescribing habits within a single institution. In many cases, excess pills are prescribed initially at discharge and again with refill prescriptions. Using our ideal number, plastic surgeons can decrease the number of opioids prescribed for this common procedure.


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