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Perioperative Inpatient Opioid Consumption Following Autologous Free-Flap Breast Reconstruction Patients: An Examination of Risk and Patient-Reported Outcomes

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The response to the unprecedented opioid crisis in the US has increased focus on multimodal pain regimens and enhanced recovery after surgery (ERAS) pathways to reduce opioid use. This study aimed to define patient and system-level factors related to perioperative consumption of opioids in autologous free-flap breast reconstruction.

Methods

We conducted a retrospective study to identify patients who underwent autologous breast reconstruction between 2010 and 2016. A multivariate linear regression model was developed to assess patient and system-level factors influencing opioid consumption. Opioid consumption was then dichotomized as total postoperative opioid consumption above (high) and below (low) the 50th percentile to afford more in-depth interpretation of the regression analysis. Secondary outcome analyses examined postoperative complications and health-related quality-of-life outcomes using the BREAST-Q.

Results

Overall, 601 patients were included in the analysis. Unilateral reconstruction, lower body mass index, older age, and administration of ketorolac and liposomal bupivacaine were associated with lower postoperative opioid consumption. In contrast, history of psychiatric diagnoses was associated with higher postoperative opioid consumption. There was no difference in the rates of postoperative complications when comparing the groups, although patients who had lower postoperative opioid consumption had higher BREAST-Q physical well-being scores.

Conclusion

System-level components of ERAS pathways may reduce opioid use following autologous breast reconstruction, but surgical and patient factors may increase opioid requirements in certain patients. ERAS programs including liposomal bupivacaine and ketorolac should be established on a system level in conjunction with continued focus on individualized care, particularly for patients at risk for high opioid consumption.

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Funding

Research reported in this publication was supported in part by a National Institutes of Health (NIH) Cancer Center Support Grant P30CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Author notes

  1. Jonas A. Nelson and Thais O. Polanco served as co-first authors and contributed equally to this work.

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jonas A. Nelson MD, MPH, Thais O. Polanco MD, Meghana G. Shamsunder MPH, Michelle Coriddi MD, Evan Matros MD, MPH, MHS, Joseph J. Disa MD, Babak J. Mehrara MD, Robert J. Allen Jr MD & Joseph H. Dayan MD

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Madeleine E. V. Hicks BS & Anoushka Afonso MD

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  1. Jonas A. Nelson MD, MPH
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Correspondence to Jonas A. Nelson MD, MPH or Joseph H. Dayan MD.

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Nelson, J.A., Polanco, T.O., Shamsunder, M.G. et al. Perioperative Inpatient Opioid Consumption Following Autologous Free-Flap Breast Reconstruction Patients: An Examination of Risk and Patient-Reported Outcomes. Ann Surg Oncol 28, 7823–7833 (2021). https://doi.org/10.1245/s10434-021-10023-z

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