Age Is Associated With Pain Experience and Opioid Use After Head and Neck Free Flap Reconstruction

Abstract

Objectives To describe pain experience and opioid use after major head and neck reconstructive surgery. Study Design Retrospective cohort study. Methods Patients undergoing major head and neck surgery with microvascular free tissue transfer (free flaps) at a tertiary academic center were included. Pain scores (0–10) and demographic and clinical data were ascertained from medical records. Discharge opioid prescriptions and refills obtained within 30 days were recorded. Patient characteristics were compared with pain scores using nonparametric rank‐sum tests and with likelihood of refill using logistic regression models to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results The study population comprised 445 patients. Median age was 60 years (interquartile range 50–68). Most patients had cancer (N = 350, 78%). The majority of free flaps were fibula (N = 153, 34%) or radial forearm (N = 159, 36%). Older patients reported significantly lower pain scores, whereas patients with opioid tolerance, anxiety, current smokers, and those undergoing larger volume resections or boney free flaps reported significantly higher pain scores. One‐quarter (N = 115, 26%) of patients obtained opioid refills. Patients aged ≥ 60 years had one‐half the odds of obtaining a refill compared with patients aged < 60 years (adjusted odds ratio [aOR] = 0.52, 95% confidence interval [CI] = 0.33–0.84), whereas surgical defect volume ≥ 100 cm3 (aOR = 1.92, 95% CI = 1.21–3.07) and higher pain score (aOR = 1.19, 95% CI = 1.07–1.32 per 1 point increase) increased the odds of refill. Conclusion Continued opioid use after discharge is common among patients undergoing major head and neck reconstruction, particularly for younger patients and after more extensive surgery. Older patients reported lower pain intensity and were less likely to obtain opioid refills, highlighting the wisdom of judicious opioid use for this vulnerable population. Level of Evidence IV Laryngoscope, 130: E469–E478, 2020

Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single‐institution retrospective analysis characterizing patients who did not require opioid therapy

“…Like in the present study, older age has been consistently shown to be associated with decreased use of opioids in patients with head and neck cancer 10,27,28 . This may be due decreased pain sensitivity in elderly populations 29 . This is the first study to report an association of having dependent children with opioid use and this may warrant further study.…”

“…10,27,28 This may be due decreased pain sensitivity in elderly populations. 29 This is the first study to report an association of having dependent children with opioid use and this may warrant further study. In addition to these socioeconomic factors, pain score during radiation therapy was associated with opioid use.…”

Reconstruction of Chronic Wounds Secondary to Injectable Drug Use with a Biodegradable Temporizing Matrix

“…Free tissue reconstruction is the gold-standard for wounds with exposed bone devoid of periosteum, but is associated with increased donor-site morbidity, cost, and postoperative pain. [11][12][13] These risks are magnified in the IDU population where ongoing drug use or relapse and poor adherence to postoperative care may increase the risk of complications and failure. 3,12 Less complex options such as skin grafting or locoregional flaps may be contraindicated secondary to debridement of the periosteum, surrounding soft-tissue fibrosis, and persistent infection.…”

“…[11][12][13] These risks are magnified in the IDU population where ongoing drug use or relapse and poor adherence to postoperative care may increase the risk of complications and failure. 3,12 Less complex options such as skin grafting or locoregional flaps may be contraindicated secondary to debridement of the periosteum, surrounding soft-tissue fibrosis, and persistent infection. 2 NPD can also be utilized to stimulate granulation for skin grafting; however, the size of the defect, possible persistent infection, and need for prolonged treatment may cause problems with this approach.…”

“…Dermal substitutes and subsequent STSG offer a potentially less complex, morbid, and costly alternative. [11][12][13] Kozak and colleagues compared outcomes after free flap, local tissue rearrangement, and Integra for complex wounds with exposed bone and tendon and demonstrated that Integra achieved over 70% success rate, at a lower total cost. 13 Dermal substitutes such as Integra and BTM also have decreased donor-site morbidity and operative times when compared with free tissue reconstruction.…”