Opioid Prescribing And Use Following Common Plastic Surgery Procedures
Colton Boudreau, MSc1, Osama Samargandi, MD1, Kaleigh MacIssac1, Adel Helmi, MD1, Connor McGuire, MD1, David Tang, MD, MEd, FRCSC1, Alison Wong, MD, FRCSC2.
1Dalhousie University, Halifax, NS, Canada, 2Johns Hopkins University, Baltimore, MD, USA.
Purpose: Overprescribing of opioids has become a topic of interest given the potential adverse outcomes associated with their use. Excess prescribing of opioids has been shown to have individual and societal impacts such as addiction, dependence and misuse. Opioids are frequently prescribed for analgesia following plastic surgery procedures. This study aims to investigate prescribing patterns and explores self-reported patient experiences with opioid use, pain control and disposal of unused tablets following common hand and breast surgeries.
Methods: Patients undergoing five common predetermined breast procedures (unilateral and bilateral augmentation mammoplasty, unilateral and bilateral reduction Mammoplasty and Insertion of tissue expander) and six common hand procedures (cubital tunnel release, extensor tendon repair, flexor tendon repair, IP joint fusion, ligament reconstruction tendon interposition, metacarpal/carpal open reduction internal fixation) were identified. A specified 14-week period was defined, and patients were identified by billing code through local hospital health information services. All procedures were carried out at a single tertiary care hospital by nine surgeons. 62 hand procedures 46 breast procedures were identified. Collaboration with Nova Scotia Provincial Monitoring Program (NSPMP) allowed for data surrounding prescription filling rates, drug type, dose and tablets dispensed. Additionally, all patients were contacted to participate in a structured telephone interview surrounding prescription awareness, pain control and disposal of excess medication.
Results: 55.4% and 41.6% of patients received and filled an opioid prescription following a hand or breast procedure, respectively. Hydromorphone was the most commonly prescribed narcotic for both hand and breast procedures. Average number of opioid tablets dispensed following hand and breast procedures was 36.1 and 31.9, respectively. 48 and 52 percent of hand and breast patients completed phone interviews. 4.2% of breast patients required an opioid refill, while no hand patients did. 73% of hand 75% of breast patients used at least one over-counter analgesic, most common being acetaminophen alone. Average self-reported pain score and total pain period was not significantly different between those using opioids and those not for both hand and breast procedures. 6.7% and 23.1% of patients report returning excess narcotics to pharmacy, while the majority report still having or self-disposing excess tablets.
Conclusions: Opioid prescriptions are frequent following the procedures studied. In general, opioids appear to be prescribed in excess as denoted by self-report low prescription usage, statistically insignificant differences in pain for those using and not using opioids and low refill rates. Additionally, the majority of unused opioids were noted to be still at home or disposed of inappropriately. Taken together, this study suggests a role for reviewing opioid prescribing patterns for common hand and breast procedures to reduce contributions of excess opioids to an ongoing opioid epidemic.
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