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Opioid prescribing practices in breast oncologic surgery-A retrospective cohort study
Élise Di Lena1,2, Natasha Barone3, Brent Hopkins1
1Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
World Journal of Surgery
|February 5, 2024
Summary
Surgeon preference, not procedure type, most impacts opioid prescribing after breast cancer surgery. Trainees prescribed fewer opioids, suggesting a need for standardized guidelines to reduce opioid-related harms.
Area of Science:
- Oncology
- Pain Management
- Pharmacology
Background:
- Postoperative opioid prescriptions are common in breast oncologic surgery, with 10%-20% of patients developing persistent use.
- Understanding prescribing patterns is crucial for developing institutional guidelines to mitigate opioid-related harms.
Purpose of the Study:
- To determine baseline opioid prescribing patterns in a high-volume breast center.
- To identify factors influencing opioid prescription amounts after breast cancer surgery.
Main Methods:
- Retrospective analysis of 392 women undergoing breast cancer surgery (January-December 2019).
- Opioid discharge prescriptions quantified as morphine milligram equivalents (MME).
- Multivariate linear regression identified factors associated with MME prescribed.
Main Results:
- Median MME prescribed was 112.5; 83.9% received co-analgesia.
- Axillary procedures (sentinel node, axillary dissection) were associated with increased MME.
- Operating surgeon was the strongest predictor of MME, with trainees prescribing less than attending surgeons.
Conclusions:
- Surgeon's practice patterns significantly influence opioid prescribing after breast cancer surgery.
- Trainee surgeons prescribe lower MME, indicating potential for standardized protocols.
- Standardized prescribing approaches are needed to optimize opioid use and reduce associated risks in breast oncology.
