Opioid Prescribing and Consumption Patterns following Outpatient Plastic Surgery Procedures

Abstract

Background: Opioid overprescribing is a nationwide problem contributing to the current epidemic. This study evaluated opioid consumption, physician prescribing, and patient satisfaction with pain control following outpatient plastic surgery procedures. Methods: Patients completed a questionnaire during their first postoperative visit. The authors queried about procedure type, quantity of opioids prescribed and consumed, days to opioid cessation, prescription refills, pain scores, use of nonopioid analgesics, and satisfaction with pain control. Results: One hundred seventy patients were included. On average, 26 tablets were prescribed and 13 were consumed. Eighty percent of patients stopped opioids by postoperative day 5. Patients rated their worst pain at 6.1 and follow-up pain at 1.9. Approximately 50 percent of patients consumed nonopioid analgesics. Ninety-six percent of patients were satisfied with their pain control. Similar findings were observed across procedure subcategories. The number of pills prescribed was not correlated with satisfaction but was predictive of worst pain level (p = 0.014). Reduction mammaplasty and abdominoplasty patients consumed the most opioids at 17 and 18.6 pills, respectively; however, first-stage alloplastic breast reconstruction had the largest percentage of patients consuming opioids at the time of follow-up (25 percent) and requiring refills (7 percent). Patients who underwent revision of their reconstructed breast reported the earliest opioid cessation, rated their pain the lowest, and were prescribed the most excess tablets. Conclusions: Plastic surgeons are prescribing almost double the amount of opioids consumed by patients after outpatient plastic surgery procedures. The results of this study may help guide prescribing practices.

Use of Transversus Abdominis Plane Block in Cosmetic Abdominoplasties: A Systematic Review of the Literature

“…A recent study showed that patients undergoing abdominoplasty and reduction mammoplasty consume the most quantity of opioids compared with patients undergoing outpatient plastic surgery procedures. 3 Although opioids are effective in pain control, they are also associated with an undesirable side effect profile, including dizziness, nausea, vomiting, pruritis, and respiratory depression. Another concerning aspect of opioid use is the potential to develop persistent opioid use.…”

An Opioid Addicted Cosmetic Patient: A Case Report and Review of the Literature for the Management of an Opioid-Dependent Cosmetic Patient

“…14 Preoperative counseling has also been recommended to assess the patients’ expectation regarding pain and discomfort following a surgical procedure. 22,24 Preoperatively, there are multiple “red flags” that should alert the surgeon to the possibility that a known opioid-dependent patient may not manage postoperatively and may suffer adverse events, for example, an uncertain address or multiple addresses, no social support structures, a false or inconsistent history, 14 multiple doctors who are prescribing opioids, other comorbidities, 18 a complex psychiatric history, 14 verbal or physical abuse of staff, non-attendance at preoperative appointments, a history of increased opioid use after previous surgeries, 10 use of immediate release formulations, 18 or a history of illegal activity.…”

“…Behavioral issues, such as patients demanding more pain medication, malingering, and desperation mentioned in the case report in the postoperative phase, are known to “also result from under medication in pain patients.” 42,43 Sometimes having a benchmark of how many opioids are usually necessary can assist in prescribing practices, for example, in outpatient plastic surgery: “reduction mammoplasty and abdominoplasty patients consumed the most opioids at 17 and 18.6 pills respectively.” 24 Data such as these can only serve as a guide, as patients’ individual needs may vary. 44…”

“…When surgeons prescribe opioids in the postoperative setting, patients should also be given instructions on how they can store and dispose of prescription opioids safely. 10 A recent study demonstrated that “plastic surgeons are prescribing almost double the amount of opioids consumed by patients after outpatient plastic surgery procedures.” 24 It is important that this over-supply of opioids is managed safely and that medication does not end up in the wrong hands.…”

Reducing pain and opioid consumption after body contouring of the breast by application of a perioperative nerve block: a systematic review

“…Abuse has previously been commented on in the obstetric [ 4 ], orthopedic [ 5 ], and otolaryngological [ 6 ] literature. Plastic surgeons, in particular, have been found to prescribe almost double the amount of opioids that patients who undergo outpatient procedures actually consume [ 7 ].…”