Prolonged Opioid Use After Breast Reconstruction Studied

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Ten percent of women were still taking prescribed opioid pain medication three months after their mastectomy with immediate breast reconstruction, according to a study in the December issue of Plastic and Reconstructive Surgery.

The researchers, working at the University of Michigan in Ann Arbor, want surgeons, and their patients, to be cognizant of the risk involved with longterm opioid use after surgery, and to consider alternative types of pain relief.

The investigators, led by Jennifer F. Waljee, MD, MPH, MS, used health benefits claims data on 4,113 women who, between 2010 and 2014, had a mastectomy for breast cancer, and immediate breast reconstruction. None of these women had an opioid prescription in the year prior to their surgery.

Ninety percent of the women filled an opioid prescription following their procedure, as do many people after invasive medical treatments. However, ten percent of the women continued to fill opioid prescriptions three months later.

The prolonged opioid use was most common with those suffering a surgical complication, typically an infection, and for patients diagnosed with anxiety. Prolonged use was less common after autologous reconstruction (reconstruction using one’s own tissue instead of implants), and for those undergoing chemotherapy.

Data analysis also showed about 75 percent of the women used implants for breast reconstruction, and that women with depression were prescribed higher opioid doses, as were those who had both breasts reconstructed. Compared to younger women, opioid doses were lower for those aged 55 to 64.

Though opioids are a standard pain relief prescription following mastectomy and breast reconstruction, the current opioid crisis (e.g., dependency, overdose) is making doctors and researchers attentive to the risks of extended use.

"Close consultation with providers in primary care, psychiatry, and pain management during the postoperative period can provide more coordinated care with opioid alternatives for these complex and potentially vulnerable patients,” conclude Dr. Waljee and colleagues.

Source: Plastic Surgery
Photo credit: Charles Williams


 
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