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Perioperative Opioids Refills In Tissue Expander-Based Breast Reconstruction: Patient Risk Factors And Prescriber Trends
Franca Kraenzlin, MD MHS, Halley Darrach, BS, Pragna N. Shetty, MPH, Justin M. Sacks, MD MBA FACS.
The Johns Hopkins School of Medicine the Department of Plastic and Reconstructive Surgery, Baltimore, MD, USA.

PURPOSE: Tissue expander-based breast reconstruction (TE-BR) is one of the most common procedures performed by board-certified plastic surgeons every year. Despite this, there is no literature on what constitutes an adequate postoperative pain regimen. Death by a physician's opioid prescription remains a prevalent problem, with roughly 17,000 people dying in 2017 alone. In this study, we aimed to develop guidance on what constitutes an adequate pain regimen for patients undergoing TE-BR.
METHODS: This study was approved by our institutional review board. We performed a retrospective review of all adult post-mastectomy patients receiving TEs over a 16-month period at one academic medical center. Patient demographics, prescriptions written, and postoperative prescriptions filled were collected. Bivariate and multivariable linear regressions were performed to observe the effects of risk factors on prescription refills.
RESULTS: We included 229 patients in this study. A 64.0% decline in oral morphine equivalents (OME) prescribed at discharge was observed over time (R2 = 0.77, p<0.01). A reduction in refill prescriptions numbers (74.1% reduction, R2 = 0.26, p<0.01) and average refill OMEs (63.5% reduction, R2 = 0.3, p=0.03) was also observed. Restrictive opioid regimens (≤150 OMEs) were not associated with an increased likelihood of requiring a refill (11.3%). Multimodal pain control did not reduce the odds of an opioid refill.
CONCLUSION: Opioid over prescription is a systemic problem in surgery. A significant reduction in the number of discharge OMEs prescribed and a reduction in opioid refills were observed. Participants receiving restrictive amounts of discharge opioids (≤150 OMEs) had the lowest rate of refills. Multimodal pain control was not associated with reduced odds of receiving a refill. Prospective studies are needed to establish adequate discharge OME amounts and to understand how the amount of OMEs written affects pain perception.


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