Changing Opioid Prescribing Algorithms in Plastic Surgery

Changing opiate prescribing practices in surgical fields without guidelines or standardizations can be a daunting task. An encouraging amount of literature has shown the benefits of reducing opioid use, but many plastic surgeons hesitate to initiate this directive. We present a practice modification designed to reduce the number of opiates prescribed and highlight the steps needed to implement a new prescribing algorithm.

In October of 2023, we implemented a new opiate algorithm for patients undergoing breast surgery. In the preintervention group, patients received 30 pills of postoperative opiates and recorded their consumption. Following the intervention, patients were given a maximum of 10 pills. To guide this new prescribing practice, we relied on pill consumption analysis from our preintervention group. In each cohort, data were collected on postoperative analgesic use per procedure.

Forty-one survey responses were included in our preintervention cohort and 10 in our postintervention cohort. A median of 5.5 pills was consumed by patients who received implant or tissue expanders, 4.75 pills for pedicled flaps, 12 pills for fat grafting, 5 pills for breast reduction, and 12.5 pills for gender affirming mastectomies. Before and after the intervention, median opiate consumption was similar at 6 pills and 5.5 pills, respectively. Patients in both cohorts would consume pills for a median of 4 days. In the preintervention group, patients had a median of 24 unused pills. This was significantly reduced to 0.5 unused pills in the postintervention cohort (P < 0.000). Refill requirements and analgesic use by the 2 groups was not significantly different (P = 0.063 and P = 0.545).

We have outlined a pathway for updating opioid prescribing algorithms in plastic surgery. Our opiate intervention significantly diminished opiate excess, reducing the risk for abuse. With growing research demonstrating the benefits of regulating prescriptions, and the best ways to implement change, surgeons can feel confident to just say yes to this meaningful reform.