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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
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Reducing Chronic Opioid Use: Long-term Impacts of Enhanced Recovery After Mastectomy Protocols
Kristen Jogerst1,2, Nikita Gupta3, Heidi E Kosiorek4
1Department of General Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ.
Annals of Surgery
|May 17, 2024
Summary
Enhanced Recovery After Surgery (ERAS) protocols significantly reduced long-term opioid use in mastectomy patients without increasing sedative use. This finding supports ERAS implementation for improved post-surgical pain management and reduced chronic medication dependence.
Area of Science:
- Oncology
- Surgical Oncology
- Anesthesiology
- Pain Management
- Pharmacology
Background:
- Enhanced Recovery After Surgery (ERAS) protocols are known to shorten hospital stays and reduce acute pain and opioid needs after mastectomy.
- The long-term effects of ERAS protocols on chronic opioid and sedative use beyond 90 days post-mastectomy remain less understood.
- Investigating these long-term outcomes is crucial for comprehensive patient recovery and management.
Purpose of the Study:
- To evaluate the impact of ERAS protocols on long-term (beyond 90 days) opioid and sedative use in patients undergoing mastectomy with or without implant-based breast reconstruction (IBBR).
- To identify factors associated with increased chronic opioid and sedative use in this patient population.
Main Methods:
- A retrospective review was conducted on 756 patients who underwent mastectomy with or without IBBR between January 2013 and December 2019.
- Patients were divided into pre-ERAS (before Feb 2017) and ERAS (after Feb 2017) groups.
- Logistic regression analysis was used to compare baseline characteristics and predict factors for chronic opioid and sedative use.
Main Results:
- Post-ERAS implementation, chronic opioid use decreased in both opioid-naive (40% to 30%) and opioid-tolerant patients (58% to 37%).
- No significant increase in chronic sedative use was observed.
- Factors associated with increased chronic opioid use included bilateral surgery, 2-stage reconstruction, higher PACU pain scores, and higher discharge opioid milligram equivalents.
Conclusions:
- ERAS protocols are associated with a significant reduction in long-term chronic opioid use following mastectomy with or without IBBR.
- These protocols do not lead to a concurrent increase in chronic sedative use.
- ERAS implementation appears to be a safe and effective strategy for mitigating long-term opioid dependence after breast cancer surgery.
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