Lumpectomy Patients are at Highest Risk for Opioid Overprescription: A Comparison Between Practice Patterns and OPEN National Guidelines.

Abstract

Background: Nearly 25% of opioid-related deaths are from prescribed opioids, and the exacerbation of the opioid epidemic by the coronavirus disease 2019 (COVID-19) pandemic underscores the urgent need to address superfluous prescribing. Therefore, we sought to align local opioid prescribing practices with national guidelines in postoperative non-metastatic breast cancer patients.

Methods: A single-institution analysis included non-metastatic breast surgery patients treated between April 2020 and July 2021. 'Overprescription' was defined as a discharge prescription quantity of oral morphine equivalents (OMEs) greater than the upper limit of the procedure-specific Michigan Opioid Prescribing Engagement Network (OPEN) recommendations. Univariable and multivariate analyses identified risk factors associated with opioid prescribing.

Results: Overall, 464 patients met the inclusion criteria: 280 patients underwent lumpectomy, and 184 patients underwent mastectomy. 52% of patients were overprescribed opioids, including 74% of lumpectomy patients (p < 0.001) and 90% of patients undergoing lumpectomy with axillary surgery (p < 0.001). Mastectomy patients were overprescribed less frequently (< 25%). The quantity of opioids prescribed at discharge did not correlate to inpatient opioid requirements (r = 0.024, p = 0.604). Increased age, tobacco use, and long surgery duration were associated with higher quantities of opioids prescribed at discharge.

Conclusion: Patients undergoing less aggressive breast surgery are at very high risk of overprescription, and real-life prescribing patterns do not correlate to national guidelines or inpatient need. Future work will optimize adherence to procedure-specific guidelines and implement tailored discharge protocols.