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Identifying Factors Predicting Prolonged Opioid Use After Mastectomy

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

Abstract

Background

Women who undergo mastectomy for breast cancer may be prone to prolonged opioid use (POU). However, risk factors for long-term opioid use after mastectomy remain unclear. This study seeks to identify risk factors for POU after mastectomy.

Patients and Methods

A single-institution database was queried for women who underwent mastectomy for breast cancer between January 2016 and December 2017. Patients were stratified based on opioid use < 90 or ≥ 90 days after mastectomy or completion of their reconstruction. Clinicopathologic and operative parameters as well as preoperative and postoperative opioid usage were compared.

Results

Patients with opioid use ≥ 90 days after last procedure (POU) had a history of preoperative opioid use (29.3% vs 8.2%, p = 0.002), were more likely to have concomitant psychiatric illness (70% vs 35.6%, p < 0.001), and had received adjuvant chemotherapy (43.1% vs 24.7%, p = 0.03). Patients with POU also had greater daily opioid doses prescribed upon discharge (59.6 mg vs 44.6 mg, p < 0.001). On multivariable analysis, preoperative opioid use (OR 3.61, 95% CI 1.16–11.22, p = 0.03), daily oral morphine equivalents prescribed at discharge (OME-D) (OR 1.02, 95% CI 1.01–1.05, p = 0.003), and psychiatric illness (OR 4.48, 95% CI 1.85–10.89, p < 0.001) were independently associated with POU. Among opioid-naïve patients, 37% were found to have POU. Among these patients, OME at discharge (OR 1.02, 95% CI 1.003–1.04, p = 0.02) and psychiatric illness (OR 3.23, 95% CI 1.25–8.31, p = 0.02) independently predicted POU.

Conclusions

Preoperative opioid use, psychiatric illness, and daily OME at discharge independently predict POU after mastectomy.

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References

  1. Hah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Analg. 2017;125(5):1733–40.

    Article  Google Scholar 

  2. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths–United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82.

    Article  Google Scholar 

  3. Uhrbrand P, Simoni AH, Olesen AE, Pedersen AB, Christiansen CF, Nikolajsen L. Opioid dependency as complication after surgery. Ugeskr Laeger. 2018;180(31):2–5.

    Google Scholar 

  4. Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504.

    Article  Google Scholar 

  5. Lee JS, Hu HM, Edelman AL, et al. New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol. 2017;35(36):4042–49.

    Article  CAS  Google Scholar 

  6. Lee JS, Howard RA, Klueh MP, et al. The impact of education and prescribing guidelines on opioid prescribing for breast and melanoma procedures. Ann Surg Oncol. 2019;26(1):17–24.

    Article  Google Scholar 

  7. Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901–6.

    Article  Google Scholar 

  8. Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016;176(9):1286–93.

    Article  Google Scholar 

  9. Keskey RC, LaJoie AS, Sutton BS, et al. Cost-effectiveness analysis of contralateral prophylactic mastectomy compared to unilateral mastectomy with routine surveillance for unilateral, sporadic breast cancer. Ann Surg Oncol. 2017;24(13):3903–10.

    Article  Google Scholar 

  10. Yao K, Sisco M, Bedrosian I. Contralateral prophylactic mastectomy: current perspectives. Int J Womens Health. 2016;8:213–223.

    Article  Google Scholar 

  11. Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. BJA. 2013;111(5):711–720.

    Article  CAS  Google Scholar 

  12. Tripathy S, Rath S, Agrawal S, et al. Opioid-free anesthesia for breast cancer surgery: an observational study. J Anaesthesiol Clin Pharmacol. 2018;34(1):35–40.

    PubMed  PubMed Central  Google Scholar 

  13. Marcusa DP, Mann RA, Cron DC, et al. Prescription opioid use among opioid-naive women undergoing immediate breast reconstruction. Plast Reconstr Surg. 2017;140(6):1081–90.

    Article  CAS  Google Scholar 

  14. Berglund DD, Rosas S, Kurowicki J, Horn B, Mijic D, Levy JC. Preoperative opioid use among patients undergoing shoulder arthroplasty predicts prolonged postoperative opioid use. J Am Acad Orthop Surg. 2019;27(15):E691–5.

    Article  Google Scholar 

  15. Bateman BT, Franklin JM, Bykov K, et al. Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women. Am J Obstet Gynecol. 2016;215(3):353.e318–51.

    Article  Google Scholar 

  16. Manchikanti L, Giordano J, Boswell MV, Fellows B, Manchukonda R, Pampati V. Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients. J Opioid Manag. 2007;3(2):89–100.

    Article  Google Scholar 

  17. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ (Clin Res Ed). 2005;330(7493):702.

    Article  Google Scholar 

  18. Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30.

    Article  Google Scholar 

  19. Jung BF, Herrmann D, Griggs J, Oaklander AL, Dworkin RH. Neuropathic pain associated with non-surgical treatment of breast cancer. Pain. 2005;118(1–2):10–14.

    Article  Google Scholar 

  20. Hill MV, McMahon ML, Stucke RS, Barth RJ, Jr. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709–14.

    Article  Google Scholar 

  21. Lillemoe HA, Newhook TE, Vreeland TJ, et al. Educating surgical oncology providers on perioperative opioid use: results of a departmental survey on perceptions of opioid needs and prescribing habits. Ann Surg Oncol. 2019;26(7):2011–18.

    Article  Google Scholar 

  22. Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ, Jr. Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg. 2018;226(6):996–1003.

    Article  Google Scholar 

  23. Kennedy-Hendricks A, Gielen A, McDonald E, McGinty EE, Shields W, Barry CL. Medication sharing, storage, and disposal practices for opioid medications among US adultssharing, storage, and disposal practices for opioidsletters. JAMA Intern Med. 2016;176(7):1027–9.

    Article  Google Scholar 

  24. Hasak JM, Roth Bettlach CL, Santosa KB, Larson EL, Stroud J, Mackinnon SE. Empowering post-surgical patients to improve opioid disposal: a before and after quality improvement study. J Am Coll Surg. 2018;226(3):235–40.

    Article  Google Scholar 

  25. Hallway A, Vu J, Lee J, et al. Patient satisfaction and pain control using an opioid-sparing postoperative pathway. J Am Coll Surg. 2019;229(3):316–22.

    Article  Google Scholar 

  26. Refai M, Andolfi M, Gentili P, Pelusi G, Manzotti F, Sabbatini A. Enhanced recovery after thoracic surgery: patient information and care-plans. J Thorac Dis. 2018;10(Suppl 4):S512–6.

    Article  Google Scholar 

  27. Deng QF, Gu HY, Peng WY, et al. Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis. Postgrad Med J. 2018;94(1118):678–93.

    Article  Google Scholar 

  28. Huang J, Cao C, Nelson G, Wilson RD. Review of enhanced recovery after surgery principles used for scheduled CD: perioperative process evaluation. J Obstet Gynaecol Can. 2018;41(12):1775–88.

    Article  Google Scholar 

  29. Rojas KE, Manasseh DM, Flom PL, et al. A pilot study of a breast surgery enhanced recovery after surgery (ERAS) protocol to eliminate narcotic prescription at discharge. Breast Cancer Res Treat. 2018;171(3):621–26.

    Article  Google Scholar 

  30. Richardson JD. Recovering from an operation. J Am Coll Surg. 2018;228(3):310–11.

    Article  Google Scholar 

  31. Lee KJ, Min BW, Bae KC, Cho CH, Kwon DH. Efficacy of multimodal pain control protocol in the setting of total hip arthroplasty. Clin Orthop Surg. 2009;1(3):155–60.

    Article  Google Scholar 

  32. Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anesth. 2001;13(7):524–39.

    Article  CAS  Google Scholar 

  33. Cho CH, Song KS, Min BW, et al. Multimodal approach to postoperative pain control in patients undergoing rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2011;19(10):1744–8.

    Article  Google Scholar 

  34. Horsley RD, Vogels ED, McField DAP, et al. Multimodal postoperative pain control is effective and reduces opioid use after laparoscopic roux-en-Y gastric bypass. Obes Surg. 2019;29(2):394–400.

    Article  Google Scholar 

  35. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014;69(2):153–66.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA

    Matthew R. Woeste MD, Neal Bhutiani MD, PhD, Anne E. Geller BS, Kelly M. McMasters MD, PhD & Nicolás Ajkay MD

  2. Department of Radiation Oncology, Univeristy of Louisville, Louisville, KY, USA

    Harriet Eldridge-Hindy MD

Authors
  1. Matthew R. Woeste MD
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  2. Neal Bhutiani MD, PhD
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  3. Anne E. Geller BS
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  4. Harriet Eldridge-Hindy MD
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  5. Kelly M. McMasters MD, PhD
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  6. Nicolás Ajkay MD
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Correspondence to Nicolás Ajkay MD.

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Woeste, M.R., Bhutiani, N., Geller, A.E. et al. Identifying Factors Predicting Prolonged Opioid Use After Mastectomy. Ann Surg Oncol 27, 993–1001 (2020). https://doi.org/10.1245/s10434-019-08171-4

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  • DOI: https://doi.org/10.1245/s10434-019-08171-4

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