Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery

Author:

Simon Natalie B.1ORCID,Assel Melissa2,Serafin Joanna2,McCready Taylor M.3,Nelson Jonas A.2ORCID,Vickers Andrew J.2,Moo Tracy‐Ann2,Tokita Hanae K.2

Affiliation:

1. Eastern Virginia Medical School Norfolk Virginia USA

2. Memorial Sloan Kettering Cancer Center New York New York USA

3. New York University Grossman School of Medicine New York New York USA

Abstract

AbstractBackground and ObjectivesWe investigated whether age, body mass index (BMI), and tissue expander placement were related to postoperative opioid requirement for patients undergoing therapeutic versus prophylactic breast surgery.MethodsPostoperative opioid consumption was evaluated for patients who underwent bilateral mastectomy with immediate implant‐based reconstruction at a freestanding ambulatory cancer surgery center between 2016 and 2021. Ordinal regression tested whether surgical indication was associated with increased postoperative opioid requirements after adjusting for age, BMI, and tissue expander placement.ResultsOf 2447 patients, 6% underwent prophylactic surgeries. Therapeutic mastectomy patients had lower postoperative opioid requirement (OR = 0.67; 95% CI: 0.50−0.91; p = 0.030), but this was not significant after adjusting for covariates (OR = 0.75; 95% CI: 0.53−1.07; p = 0.2). Opioid use increased with higher BMI (OR = 1.06; 95% CI: 1.05−1.08; p < 0.001) and decreased with age (OR = 0.97; 95% CI: 0.96−0.98; p < 0.001) with therapeutic mastectomy patients being older (median 46 vs. 39). The subpectoral tissue expander group had nearly double the postoperative opioid requirement compared to prepectoral placement (OR = 1.86; 95% CI: 1.55−2.23; p < 0.001).ConclusionsIncreased postoperative opioid requirement in women undergoing prophylactic procedures is best explained by age. Mastectomy patients should be counseled similarly about postoperative pain irrespective of indication. A larger prophylactic mastectomy sample is required to provide more precise estimates.

Funder

Foundation for Anesthesia Education and Research

National Institutes of Health

Publisher

Wiley

Subject

Oncology,General Medicine,Surgery

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