Opioid prescribing patterns for breast reconstruction in the United States

Opioid prescribing practices following breast reconstruction vary considerably among plastic surgeons. We incorporated recently available data from a national surgical database to evaluate opioid prescription rates, patterns, and renewal depending on demographic and surgical factors.

Adult female patients who underwent breast reconstruction in the 2024 National Surgical Quality Improvement Program (NSQIP) dataset were identified. Patients with postoperative complications were excluded. The main outcome of interest was opioid prescription at discharge. The secondary outcome was prescription renewal. Demographic and clinical predictors were assessed in a multivariable logistic regression model (p<0.05).

Among the 12,338 patients included, 8712 (70.6%) were prescribed opioid medications at discharge. The most common prescription was 20 pills of oxycodone 5 mg q6h. The median (IQR) morphine milligram equivalent (MME) was 113 (80-150). Average MME was the highest in immediate autologous reconstruction (144.0±74.9) and lowest in delayed direct-to-implant (DTI) reconstruction (108.1±53.2). When compared to immediate tissue expander (TE) reconstruction, immediate autologous (OR: 0.30, 95% confidence interval [CI]: 0.26-0.36), delayed autologous (OR: 0.48, 95% CI: 0.42-0.56), and delayed DTI (OR: 0.84, 95% CI: 0.75-0.94) predicted lower odds of opioid prescription. The rate of prescription renewal was 4.5%. All reconstructive modalities conferred lower odds of renewal (p<0.05) except delayed TE reconstruction (OR: 0.85, 95% CI: 0.56-1.27) when compared to immediate TE.

Opioid medications are prescribed following most breast reconstruction procedures, but renewal is infrequent (<5%), which may indicate possible initial prescription excess. Among the reconstruction modalities, TE reconstruction was found to be associated with significantly higher odds of initial opioid prescription and subsequent prescription renewal.