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Enhanced Recovery Minimizes Opioid Use and Hospital Stay for Patients Undergoing Mastectomy with Reconstruction

  • Caroline J. McGugin
  • Suzanne B. Coopey
  • Barbara L. Smith
  • Bridget N. Kelly
  • Carson L. Brown
  • Michele A. Gadd
  • Kevin S. Hughes
  • Michelle C. SpechtEmail author
Breast Oncology

Abstract

Background

This study examined the effects of an enhanced recovery program on inpatient opioid requirements and hospital length of stay (LOS) for mastectomy patients undergoing immediate reconstruction.

Methods

An enhanced recovery program for patients undergoing mastectomy with immediate tissue expander (TE) or implant reconstruction was evaluated by comparing a contemporary cohort of 611 patients in 2016–2018 with a historical cohort of 188 patients in 2010. Opioid use and LOS were compared over time and stratified by laterality, mastectomy type, axillary procedure, and reconstruction. Associations were assessed by uni- and multivariate analyses.

Results

In 2010, 95.2% of patients required intravenous (IV) opioids, with a last dose 15.5 h after completion of surgery, compared with 68.7% of patients in 2016–2018, with a last dose 1.8 h after surgery (p < 0.001). Patients prescribed gabapentin postoperatively were less likely to require inpatient IV or oral opioids (p < 0.001). The mean LOS decreased from 37 h in 2010 to 27.5 h in 2016–2018 without an increase in the readmission rate (6.9% vs. 4.1%; p = 0.112). Patients were more likely to stay more than one night if they were older (p = 0.012), had undergone bilateral mastectomies (p < 0.001) or TE reconstruction (p = 0.012), and had surgery in 2010 compared with 2016–2018 (p < 0.001). Even after adjustment for LOS, IV opioid use remained significantly associated with year of surgery (p < 0.001).

Conclusions

Compared with 2010, patients undergoing mastectomy with TE or implant reconstruction in 2016–2018 required less inpatient opioids and had decreased LOS. The authors attribute this to an enhanced recovery program focused on preoperative counseling, non-opioid analgesics, and improved surgical efficiencies.

Notes

Acknowledgement

This study was conducted with support from Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.

Disclosure

All authors declare that they have no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Caroline J. McGugin
    • 1
  • Suzanne B. Coopey
    • 1
  • Barbara L. Smith
    • 1
  • Bridget N. Kelly
    • 1
  • Carson L. Brown
    • 1
  • Michele A. Gadd
    • 1
  • Kevin S. Hughes
    • 1
  • Michelle C. Specht
    • 1
    Email author
  1. 1.Department of Surgical OncologyMassachusetts General HospitalBostonUSA

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