Opioid Usage Following Outpatient Breast Surgery: Are Physicians Part of the Problem?

Purpose: The increasing rate of opioid abuse warrants standardization of postoperative pain management. The purpose of this study is to analyze the use of opioids in pain control and patient satisfaction following ambulatory breast surgery. Methods: This is a prospective study of a consecutive series of patients undergoing secondary breast reconstruction [SBR: n=60)] or breast reduction [BR:n=35]. All patients were given a pain questionnaire preoperatively. Postoperatively, women received 30 tablets of oxycodone 5.0mg/acetaminophen 325mg. Patients were contacted three times postoperatively: postoperative day [POD] 3-5, 8-10, and >/30. All patients were queried on narcotic usage, pain level (0-10), and satisfaction with pain control. Patients with allergies or taking narcotics preoperatively were excluded. Results: Most in SBR group (61.5%) had stopped taking opioids by POD5. Patients consumed a mean of 11.4 pills following SBR and 17.5 after BR. A majority reported feeling satisfied with their pain management. At POD>/30, most experienced very mild pain with an improvement of 3.74 points following BR. There were 18.6 and 12.5 pills per patient leftover for both SBR and BR, respectively. 1,551 unused pills were leftover entire cohort at POD>/30. There was not a significant difference in average pain scores and interference with enjoyment or activity between those that did or did not take pain medication. Conclusion: This commonly prescribed pain regimen provides adequate pain relief and satisfaction for breast surgery with a substantial number of leftover pills. We as prescribers should be aware of discrepancies. Thirty opioids after outpatient breast surgery appears unnecessary and excessive. This paper was previously presented at the Southeastern Society of Plastic and Reconstructive Surgeons in June of 2017. AH has nothing to disclose JB has nothing to disclose LK has nothing to disclose AL has nothing to disclose Corresponding Author: Albert Losken, M.D., 550 Peachtree Street NE, Suite 9000, Atlanta, GA 30308, 404-686-8143, alosken@emory.edu ©2018American Society of Plastic Surgeons

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