Opioid Coprescribing with Sedatives after Implant-Based Breast Reconstruction

Area of Science:

• Oncology
• Plastic Surgery
• Pharmacology

Background:

• Skeletal muscle relaxants and benzodiazepines are often used to manage postoperative muscle spasms.
• Regulatory bodies like the CDC and FDA advise against co-prescribing these with opioids due to overdose risks.
• The study investigates the incidence of co-prescribing opioids with muscle relaxants or benzodiazepines in patients undergoing implant-based breast reconstruction.

Purpose of the Study:

• To determine the frequency of co-prescribing opioids with skeletal muscle relaxants or benzodiazepines post-implant-based breast reconstruction.
• To identify factors associated with these co-prescribing practices.
• To assess the impact of co-prescribing on opioid refill rates within 90 days.

Main Methods:

• Analysis of healthcare claims data for women aged 18-64 who had implant-based breast reconstruction (Jan 2008 - June 2019).
• Identification of patients who filled prescriptions for opioids, skeletal muscle relaxants, and/or benzodiazepines perioperatively.
• Statistical analysis to determine co-prescribing frequencies, associated risk factors, and correlation with opioid refills.

Main Results:

• 86.7% of patients received perioperative opioid prescriptions.
• Co-prescribing rates included: opioids and benzodiazepines (27.7%), opioids and skeletal muscle relaxants (14.4%), and all three (2.4%).
• Factors like acellular dermal matrix use, immediate reconstruction, and anxiety history were linked to co-prescribing. Co-prescribing significantly increased the likelihood of opioid refills.

Conclusions:

• Almost half of patients received opioids with benzodiazepines, skeletal muscle relaxants, or both.
• Co-prescribing opioids with skeletal muscle relaxants may increase overall opioid use and sedation risk, warranting avoidance.
• Developing strategies to manage post-reconstruction pain without sedatives is essential to curb high-risk prescribing.