Long-Term Opioid Use After Free Flap Breast Reconstruction: Incidence and Associated Factors.

IF 0.7 4区 医学 Q4 SURGERY Plastic surgery Pub Date : 2025-02-01 Epub Date: 2023-09-07 DOI:10.1177/22925503231198092
Joshua B Cadwell, Minji Kim, Francis D Graziano, Meghana Mehta, Ken Seier, Kay See Tan, Jonas A Nelson, Anoushka M Afonso
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Abstract

Background: Opioid dependence can occur in 6% to 10% of patients undergoing breast reconstruction. With the expansion of interdisciplinary initiatives to decrease opioid use after surgery, an updated look at the incidence of and risk factors for prolonged opioid dependence after free flap breast reconstruction is essential. Methods: We retrospectively identified all cases of free flap breast reconstruction completed at our institution from 2017 to 2020. Patients undergoing additional surgery within 120 days of the free flap procedure were excluded. Postoperative opioid prescriptions were identified; prolonged opioid use was defined as the receipt of additional prescriptions 91 to 120 days after surgery. Demographic and perioperative variables were assessed for their relationship with prolonged opioid use by logistic regressions. Results: A total of 732 patients were included in the final analysis; of these, 15 patients (2%) received additional opioid prescriptions 91 to 120 days after surgery (ie, had prolonged opioid use). Univariable associations were identified between prolonged opioid use and intraoperative morphine milliequivalents (OR = 2.3 per 50 units [95% CI, 1.5-3.5]; P < .001), opioid prescriptions 31 to 60 days after surgery (OR = 16.1 [95% CI, 4.0-65.0]; P < .001) and 61 to 90 days after surgery (OR = 89.4 [95% CI, 13.7-584.5]; P < .001), and history of substance use disorder (OR = 8.3 [95% CI, 2.2-31.6]; P = .002), anxiety (OR = 3.8 [95% CI, 1.2-12.1]; P = .023), or mood disorder (OR = 12.7 [95% CI, 1.3-121.3]; P = .027). Conclusion: In our cohort, 2% of patients who underwent autologous breast reconstruction (15/732) had prolonged opioid use. The currently used perioperative opioid minimization initiatives may benefit patients undergoing autologous breast reconstruction.

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游离皮瓣乳房重建后长期阿片类药物的使用:发生率及相关因素
背景:阿片类药物依赖可发生在6%至10%的乳房重建患者。随着减少术后阿片类药物使用的跨学科倡议的扩大,对自由皮瓣乳房重建后长期阿片类药物依赖的发生率和危险因素进行更新研究是必不可少的。方法:回顾性分析2017年至2020年在我院完成的所有游离皮瓣乳房重建病例。在游离皮瓣手术后120天内接受额外手术的患者被排除在外。术后确定阿片类药物处方;延长阿片类药物使用定义为术后91至120天收到额外处方。通过logistic回归评估人口统计学和围手术期变量与阿片类药物长期使用的关系。结果:共纳入732例患者;其中,15名患者(2%)在手术后91至120天(即延长阿片类药物使用)接受了额外的阿片类药物处方。延长阿片类药物使用时间与术中吗啡毫当量之间存在单变量关联(OR = 2.3 / 50单位[95% CI, 1.5-3.5];P < 0.001),术后31 ~ 60天开具阿片类药物处方(OR = 16.1 [95% CI, 4.0 ~ 65.0];P < 0.001)和术后61 ~ 90天(OR = 89.4 [95% CI, 13.7 ~ 584.5];P < 0.001),物质使用障碍史(OR = 8.3 [95% CI, 2.2-31.6];P = .002)、焦虑(OR = 3.8 [95% CI, 1.2-12.1];P = 0.023)或情绪障碍(or = 12.7 [95% CI, 1.3-121.3];p = 0.027)。结论:在我们的队列中,2%的自体乳房重建患者(15/732)长期使用阿片类药物。目前使用的围手术期阿片类药物最小化举措可能有利于自体乳房重建患者。
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来源期刊
Plastic surgery
Plastic surgery Medicine-Surgery
CiteScore
1.70
自引率
0.00%
发文量
73
期刊介绍: Plastic Surgery (Chirurgie Plastique) is the official journal of the Canadian Society of Plastic Surgeons, the Canadian Society for Aesthetic Plastic Surgery, Group for the Advancement of Microsurgery, and the Canadian Society for Surgery of the Hand. It serves as a major venue for Canadian research, society guidelines, and continuing medical education.
期刊最新文献
A 5-Year Analysis of Saudi Arabian Applications to Plastic Surgery Residency Training in Canada. Rectovaginal Fistula Repair Following Vaginoplasty in Transgender Females: A Systematic Review of Surgical Techniques. Current Practices and Trends of Plastic and Oncoplastic Breast Surgeons in Canada. Safety of Cefazolin Perioperative Prophylaxis in Plastic Surgery Patients With Penicillin Allergy: A Retrospective Chart Review. Long-Term Opioid Use After Free Flap Breast Reconstruction: Incidence and Associated Factors.
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