Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction

Area of Science:

• Oncology
• Plastic Surgery
• Pain Management

Background:

• Opioid overprescription following mastectomy with immediate reconstruction is a significant concern.
• Current prescribing practices often lead to excess unused opioids in the community.
• Patient satisfaction and pain management needs must be balanced with opioid stewardship.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative for opioid prescribing after mastectomy with immediate reconstruction.
• To develop evidence-based guidelines to standardize postdischarge opioid prescriptions.
• To assess the impact of guidelines on opioid utilization, patient satisfaction, and refill rates.

Main Methods:

• A quality improvement initiative involving a multi-phase study.
• Surveying patients undergoing mastectomy with tissue expander reconstruction regarding pain medication use, satisfaction, and refills.
• Calculating total oral morphine milligram equivalents (MMEs) and revising prescribing guidelines based on data collected in each phase.

Main Results:

• Initial phases showed significant overprescription, with a large percentage of prescribed opioids unused (up to 77%).
• Implementation of revised guidelines led to a substantial reduction in prescribed MMEs (from 550-900 MMEs to 98 MMEs).
• Despite reduced prescribing, high patient satisfaction (up to 93%) was maintained, with low refill rates (2 patients requiring refills in Phase IV).

Conclusions:

• Significant overprescription of opioids occurs after elective breast surgery, highlighting a need for standardized guidelines.
• Practice guidelines are effective in reducing opioid prescribing quantities without compromising patient satisfaction.
• Careful implementation of opioid reduction strategies is crucial to avoid unintended consequences like decreased patient satisfaction.