Opioid Consumption After Gender-Affirming Mastectomy and Two Other Breast Surgeries

Kortney A Robinson; Sarah Duncan; Jasmine Austrie; Aaron Fleishman; Adam Tobias; Ruben A Hopwood; Gabriel Brat

doi:10.1016/j.jss.2019.12.043

Opioid Consumption After Gender-Affirming Mastectomy and Two Other Breast Surgeries

J Surg Res. 2020 Jul:251:33-37. doi: 10.1016/j.jss.2019.12.043. Epub 2020 Feb 25.

Authors

Kortney A Robinson¹, Sarah Duncan², Jasmine Austrie², Aaron Fleishman², Adam Tobias², Ruben A Hopwood³, Gabriel Brat⁴

Affiliations

¹ Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: Krobins8@bidmc.harvard.edu.
² Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
³ The Danielsen Institute, Boston University, Boston, Massachusetts.
⁴ Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts.

PMID: 32109744
DOI: 10.1016/j.jss.2019.12.043

Abstract

Background: There are few studies that evaluate patient-reported opioid consumption after discharge from surgery. In addition, there has been a call for "special care in prescribing opioids" for lesbian, gay, bisexual, transgender, questioning patients. Here, we evaluate if patients undergoing gender-affirming mastectomy (GAM) require different amounts of opioids for pain management after discharge compared alongside two surgeries with similar surgical exposure.

Materials and methods: From October 2017 to July 2018, patients undergoing oncologic mastectomy without reconstruction, mammoplasty reduction, or gender-affirming mastectomy at a single institution were enrolled in a phone survey study to quantify opioids consumed after discharge from surgery. Patient information was captured from the medical record. A total of 170 patients were called between 14 and 30 d after discharge and were asked to count unused pills from their opioid prescription.

Results: A total of 99 patients participated and provided pill counts. There were differences between prescribed and consumed opioids within each surgery. Patients who underwent oncologic mastectomy were prescribed and consumed the lowest amounts of opioids. There were significantly more opioids prescribed to patients with GAM than mammoplasty reduction, but consumption was not statistically different. Patients with oncologic mastectomy, mammoplasty reduction, and GAM consumed a median of 0, 10, and 15 five mg oxycodone equivalent tablets, respectively.

Conclusions: Despite similar approaches, surgeries had different opioid prescribing and use profiles. Generally, all patients were overprescribed opioids. Overprescribing may be especially problematic in patients with known higher risk of misuse and substance abuse. Granular data on patient consumption, demographics, and preoperative risk factors for opioid misuse may improve prescribing practices.

Keywords: Breast reduction; Breast surgery; Gender affirmation; Mastectomy; Opioids; Postoperative pain.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Analgesics, Opioid / administration & dosage*
Humans
Mammaplasty / adverse effects*
Mastectomy / adverse effects*
Middle Aged
Pain, Postoperative / drug therapy*
Pain, Postoperative / etiology
Practice Patterns, Physicians' / statistics & numerical data*

Substances

Analgesics, Opioid