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Identifying Factors Predicting Prolonged Opioid Use After Mastectomy
Matthew R Woeste1, Neal Bhutiani1, Anne E Geller1
1Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
Annals of Surgical Oncology
|January 23, 2020
Summary
Preoperative opioid use, psychiatric illness, and high discharge opioid doses predict prolonged opioid use after mastectomy. These factors are crucial for identifying at-risk patients and guiding pain management strategies.
Area of Science:
- Oncology
- Pain Management
- Psychiatry
Background:
- Mastectomy for breast cancer can lead to prolonged opioid use (POU).
- Risk factors for POU following mastectomy are not well understood.
- Identifying these risk factors is crucial for effective pain management and patient outcomes.
Purpose of the Study:
- To identify predictors of prolonged opioid use (POU) after mastectomy.
- To analyze clinicopathologic, operative, and opioid usage parameters.
- To inform targeted interventions for patients at risk of POU.
Main Methods:
- Retrospective analysis of a single-institution database of women undergoing mastectomy.
- Stratification of patients based on opioid use duration (<90 days vs. ≥90 days).
- Comparison of clinicopathologic, operative, and opioid usage data between groups.
Main Results:
- Preoperative opioid use, concomitant psychiatric illness, and adjuvant chemotherapy were associated with POU.
- Higher daily opioid doses prescribed at discharge predicted POU.
- Multivariable analysis confirmed preoperative opioid use, psychiatric illness, and discharge opioid dose as independent predictors of POU.
Conclusions:
- Preoperative opioid use, psychiatric illness, and daily oral morphine equivalents at discharge are independent predictors of POU.
- These findings highlight the importance of pre-existing conditions and initial pain management in long-term opioid use.
- Targeted interventions for high-risk patients are warranted to mitigate POU.
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