Opioid Use following Outpatient Breast Surgery: Are Physicians Part of the Problem?

Abstract

Therapeutic, IV.

Narcotics and breast surgery: a review of current literature

“…Patients undergoing breast reduction stopped all narcotics by postoperative Day 30, whereas 7.1% of patients undergoing secondary breast reconstruction continued to use narcotics beyond postoperative Day 30. This supports the data that suggest breast cancer patients are at increased risk of chronic opioid use, perhaps due to patient risk factors such as confounding anxiety and/or depression often associated with the diagnosis of breast cancer [1,10] . The authors warned physicians to be cognizant of patient factors, such as a new cancer diagnosis, that put patients at higher risk of opioid dependence [10] .…”

“…Persistent opioid use and overprescribing of opioids is well studied within the surgical oncology patient population [10] . In a study by Lee et al [11] , the authors aimed to understand the risk of developing new persistent opioid use after curative-intent cancer surgery.…”

“…Several efforts have been made to optimize pain control in the perioperative period while decreasing the number of opioids prescribed. Hart et al [10] performed a unique analysis of opioids, pain control, and patient satisfaction following ambulatory breast surgery, including breast reduction and secondary breast reconstruction (implant exchange, capsulectomy/capsulotomy, fat grafting, scar revision, nipple reconstruction and/or combination of procedures). They found clear evidence of opioid over-prescribing for this patient population [10] .…”

“…Hart et al [10] performed a unique analysis of opioids, pain control, and patient satisfaction following ambulatory breast surgery, including breast reduction and secondary breast reconstruction (implant exchange, capsulectomy/capsulotomy, fat grafting, scar revision, nipple reconstruction and/or combination of procedures). They found clear evidence of opioid over-prescribing for this patient population [10] . To evaluate opioid prescribing habits, patients were surveyed on pre-and postoperative narcotic use, pain level and satisfaction with pain control.…”

Doing Our Part to Mitigate the Opioid Crisis

“…Similar findings were seen in a study of opioid use following secondary reconstruction published by Hart et al, in which the authors reported that while prescribing 30 opioid pills provided patients with enough medication, there were many pills left unused. They also found that patients stopped using opioids by postoperative day 5, with an average of 18.6 excess tablets 8 . As would be expected, Park et al 7 report that opioid consumption is correlated with the extent/invasiveness of the surgical procedure.…”