Patient-reported opioid use for tissue expander–based breast reconstruction

Boerum, Melody Scheefer Van; Mann, Sara; Veith, Jacob; Collier, Willem; Hosein, Rayaad C; Manum, Joanna S.; Agarwal, Jayant P.; Kwok, Alvin C.

doi:10.1016/j.bjps.2021.03.114

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Previous studies have demonstrated preoperative opioid use, increased inpatient opioid consumption, younger age, and psychiatric comorbidities as predictors of increased opioid consumption. 10,[22][23][24] Specifically, numerous studies have reported that patients with anxiety and depression tend to require more opioids postoperatively, highlighting the need for multidisciplinary, integrated care for those with psychiatric comorbidities to improve pain management postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…While previous studies have characterized patterns of opioid consumption after tissue expander placement, most of the literature quantifying opioid consumption after autologous breast reconstruction describes inpatient opioid consumption only or quantifies outpatient use by amount of opioids prescribed rather than the amount taken. [9][10][11][12] Little is known about exact outpatient opioid consumption after discharge from deep inferior epigastric perforator (DIEP) flap breast reconstruction.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention

Marquez,

Chow,

Moss

et al. 2024

J Reconstr Microsurg

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Introduction: There is limited evidence for appropriate postoperative opioid prescribing in autologous breast reconstruction. We sought to describe postoperative outpatient prescription opioid use following discharge after deep inferior epigastric perforator (DIEP) breast reconstruction with and without an educational video. Methods: Patients undergoing DIEP reconstruction were given a 28-day postoperative pain and medication logbook from August 2022-June 2023. Our practice implemented an educational video upon discharge on proper opioid consumption. Descriptive statistics on patient characteristics, intraoperative and postoperative opioid consumption, and outpatient prescription opioid use after discharge were compared between the two cohorts. Results: A total of 53 logbooks were completed with 20 patients in the no video cohort and 33 in the video cohort. On average, the days to cessation of opiates was longer in the no video cohort (8.2 days versus 5.1 days, p=0.003). The average number of oxycodone 5mg equivalents consumed following discharge was 13.8 in the no video cohort and 7.8 in the video cohort, which was statistically significant (p=0.01). Overall, the percentage of opioids prescribed that were consumed in the video cohort was 28.3% versus 67.1% in the no video cohort. Conclusion: For patients discharging home after DIEP reconstruction, we recommend a prescription for twelve oxycodone 5 mg tablets. With the use of an educational video regarding proper opioid consumption, we were able to reduce the total outpatient opioid use to five oxycodone 5 mg tablets following hospital discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention

Marquez,

Chow,

Moss

et al. 2024

J Reconstr Microsurg

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“…When comparing opioid usage between prepectoral versus subpectoral reconstruction, one study has shown a reduction in immediate postoperative utilization of opioids in their prepectoral versus subpectoral cohorts [ 22 ]. Van Boerum et al also showed that patients report opioid use for a mean of 7.4 ± 6.5 (standard deviation) days after being discharged home and that prepectoral placement was associated with lower post-discharge opioid consumption [ 23 ]. Though we did not make a comparison to subpectoral reconstruction in our study, these results suggest that the pain in prepectoral reconstruction can mostly be controlled with non-opioid medications, which the majority of our patients took throughout their time in the study.…”

Section: Discussionmentioning

confidence: 99%

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study

Tiongco¹,

Puthumana²,

Khan³

et al. 2022

Cureus

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Purpose: Two-stage tissue expander (TE) to implant breast reconstruction is commonly performed by plastic surgeons. Prepectoral implant placement with acellular dermal matrix (ADM, e.g., AlloDerm®) reinforcement is evidenced by minimal postoperative pain. However, the same is not known for TE-based reconstruction. We performed this study to explore the use of complete AlloDerm® reinforcement of breast pocket tissues in women undergoing unilateral or bilateral mastectomies followed by immediate, two-stage tissue expansion in the prepectoral plane.Methods: Patients (n = 20) aged 18-75 years were followed prospectively from their preoperative consult to 60 days post-TE insertion. The pain visual analog scale (VAS), Patient Pain Assessment Questionnaire, Subjective Pain Survey, Brief Pain Inventory-Short Form (BPI-SF), postoperative nausea and vomiting (PONV) survey, BREAST-Q Reconstruction Module, and short-form 36 (SF-36) questionnaires were administered. Demographic, intraoperative, and 30-and 60-day complications data were abstracted from medical records. After TE-to-implant exchange, patients were followed until 60 days postoperatively to assess for complications.Results: Pain VAS and BPI-SF pain interference scores returned to preoperative values by 30 days post-TE insertion. Static and moving pain scores from the Patient Pain Assessment Questionnaire returned to preoperative baseline values by day 60. The mean subjective pain score was 3.0 (0.5 standard deviation) with seven patients scoring outside the standard deviation; none of these seven patients had a history of anxiety or depression. Median PONV scores remained at 0 from postoperative day 0 to day 7. Patient-reported opioid use dropped from 89.5% to 10.5% by postoperative day 30. BREAST-Q: Sexual well-being scores significantly increased from preoperative baseline to day 60 post-TE insertion. Changes in SF-36 physical functioning, physician limitations, emotional well-being, social functioning, and pain scores were significantly different from preoperative baseline to day 60 post-TE insertion. Five participants had complications within 60 days post-TE insertion. One participant experienced a complication within 60 days after TE-to-implant exchange.Conclusions: We describe pain scores, opioid usage, patient-reported outcomes data, and complication profiles of 20 consecutive patients undergoing mastectomy followed by immediate, two-stage tissue expansion in the prepectoral plane. We hope this study serves as a baseline for future research.

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“…Two weeks after discharge, we invited eligible patients via email to complete a web‐based REDCap survey (Supplement S1). We selected this time point based on prior studies suggesting that up to 96.8% of patients cease using opioids by 2 weeks after discharge 41–43 . For outpatient surgery, the discharge date was the same as the surgery date.…”

Section: Methodsmentioning

confidence: 99%

“…We selected this time point based on prior studies suggesting that up to 96.8% of patients cease using opioids by 2 weeks after discharge. [41][42][43] For outpatient surgery, the discharge date was the same as the surgery date. For inpatient surgery, we used the discharge date to ensure patients had an adequate amount of time to use their opioids at home.…”

Section: Study Setting Participants and Designmentioning

confidence: 99%

Evaluating a health system‐wide opioid disposal intervention distributing home‐disposal bags

Huang,

Bleicher,

Torre

et al. 2023

Health Services Research

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ObjectiveTo evaluate a health system‐wide intervention distributing free home‐disposal bags to surgery patients prescribed opioids.Data Sources and Study SettingWe collected patient surveys and electronic medical record data at an academic health system.Study DesignWe conducted a prospective observational study. The bags were primarily distributed at pharmacies, though pharmacists delivered bags to some patients. The primary outcome was disposal of leftover opioids (effectiveness). Secondary outcomes were patient willingness to dispose and factors associated with disposal (effectiveness), recalling receipt of the bag (reach), and recalling receipt of bags and disposal over time (maintenance). We used a modified Poisson regression to evaluate the relative risk of disposal. Inverse probability of treatment weighting, based on propensity scores, was used to account for differences between survey responders and non‐responders and reduce nonresponse bias.Data Collection/Extraction MethodsFrom August 2020 to May 2021, we surveyed patients 2 weeks after discharge (allowing for home opioid use). Eligibility criteria were age ≥18, English being primary language, valid email address, hospitalization ≤30 days, discharge home, and an opioid prescription sent to a system pharmacy.Principal FindingsWe identified 5134 patients with 2174 completing the survey (response rate 42.3%). Among respondents, 1375 (63.8%) recalled receiving the disposal bag. Among 1075 respondents with leftover opioids, 284 (26.4%) disposed, 552 (51.3%) planned to dispose, 79 (7.4%) did not plan to dispose, 69 (6.4%) had undecided, and 91 (8.5%) had not considered disposal. Recalling receipt of the bag (incidence rate ratio [IRR] 1.25, 95% confidence interval [CI] 1.13–1.37) was positively associated with disposal. Patients who used opioids in the last year were less likely to dispose (IRR 0.82, 95% CI 0.73–0.93). Disposal rates remained stable over the study period while recalling receipt of bags trended up.ConclusionsA pragmatic implementation of a disposal intervention resulted in lower disposal rates than prior trials.

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Patient-reported opioid use for tissue expander–based breast reconstruction

Cited by 4 publications

References 22 publications

Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention

Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study

Evaluating a health system‐wide opioid disposal intervention distributing home‐disposal bags

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