E41: Persistent Opioid Use in Women Undergoing Curative-Intent Breast Cancer Surgery in 2020

ePoster Abstract Author(s)

Megan M. McLaughlin

Medical Student
University of Miami Miller School of Medicine
Miami, Florida, United States

Submitter(s)

Megan M. McLaughlin

Medical Student
University of Miami Miller School of Medicine
Miami, Florida, United States

Author(s)

Megan M. McLaughlin

Medical Student
University of Miami Miller School of Medicine
Miami, Florida, United States
RM

Rohan Mangal, MSc

Medical Student
1University of Miami Miller School of Medicine, Miami, Florida, United States
AD

Anshumi Desai, MD

Fellow
University of Miami Miller School of Medicine, Department of Surgery, Division of Surgical Oncology, United States
DS

Devinder Singh, MD

Assistant Professor of Surgery
Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami, Miami, Florida, United States
KT

Kashyap Tadisina, MD

Assistant Professor of Surgery
Dewitt Daughtry Department of Surgery, University of Miami, Miami, Florida; Sylvester Comprehensive Cancer Center, Miami, FL, United States
JM

Juan Mella Catinchi, MD

Assistant Professor of Surgery
Dewitt Daughtry Department of Surgery, University of Miami, Miami, Florida; Sylvester Comprehensive Cancer Center, Miami, FL, United States
Neha Goel, MD, MPH

Associate Professor of Surgery
Dewitt Daughtry Department of Surgery, University of Miami, Miami, Florida; Sylvester Comprehensive Cancer Center, Miami, FL
Miami, Florida, United States
Susan B. B. Kesmodel, MD, FACS

Professor of Surgery
Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
Miami, Florida, United States
KR

Kristin Rojas, M.D.

Assistant Professor of Surgery
Dewitt Daughtry Department of Surgery, University of Miami, Miami, Florida, United States

Introduction: With COVID-19 superimposed on the opioid crisis, 2020 drug overdoses hit an all-time high, but changes in postoperative opioid prescription habits remain undescribed. This study aims to quantify the rate of persistent postoperative opioid use in breast cancer patients and evaluate factors associated with opioid refills.

Methods: A single-institution retrospective cohort study included breast cancer patients undergoing curative-intent breast cancer surgery in 2020. Those with an existing opioid prescription were excluded. Opioids were quantified using oral morphine equivalents (OMEs). Descriptive statistics compared demographics, treatment variables, pain scores, and opioids received in the context of pandemic timing. The primary outcome, opioid refill within 6 months, was compared using Mann Whitney U testing and logistic regression determined if the refill risk was associated with demographics, surgery type, or opioids received.

Results: 390 patients met inclusion criteria: 152 (39%) underwent mastectomy, 227 (58%) underwent lumpectomy, and 106 (27%) received reconstruction. Median age was 58. 370 (95%) were discharged with an opioid. The median OMEs prescribed was 114 (15 tabs of 5mg oxycodone). Within 6 months, 106 (27%) received an opioid refill and 34% of refills were not in a surgical context. Demographics, tobacco use, tumor stage, surgeon, opioid type, pain score, and COVID timing were similar between those who did and didn’t refill. 60 (57%) of mastectomy patients received refills, significantly more than the 40 (38%) of lumpectomy patients (p< 0.001). Age, language, race, insurance, and tobacco use were not associated with refills. On multiple logistic regression, mastectomy and reconstruction were both associated with refill risk after controlling for OMEs prescribed. In patients who received refills outside of another surgery, mastectomy increased refill risk by 50% (95% CI [0.092, 1.901]) and reconstruction increased refill risk by 74% (95% CI [1.15, 2.32]). Controlling for demographics, surgical modality, and reconstruction, OMEs at discharge was still positively associated with refill risk: each OME increased the risk by .8% (95% CI [1.004, 1.012]), translating to a 6% increase per 5mg oxycodone tablet prescribed.

Conclusions: Prescribing greater amounts of opioids after breast cancer surgery, namely mastectomy and reconstruction, puts patients at higher risk of persistent opioid use. Future work will incorporate these findings to design thoughtful prescribing practices and promote alternative pain management strategies to decrease the risk of chronic opioid use.

Learning Objectives:

understand the impact of the COVID-19 pandemic on opioid prescription rates and persistent postoperative opioid use in breast cancer patients undergoing surgery in 2020.
identify the factors, including surgical modality and oral morphine equivalents (OMEs) prescribed at discharge, that are associated with opioid refills within a 6-month postoperative period.
assess the need for alternative pain management strategies and improved prescribing practices to reduce the risk of persistent opioid use and opioid use disorder in breast cancer surgery patients.