Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery Journal Article
| Authors: | Simon, N. B.; Assel, M.; Serafin, J.; McCready, T. M.; Nelson, J. A.; Vickers, A. J.; Moo, T. A.; Tokita, H. K. |
| Article Title: | Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery |
| Abstract: | Background and Objectives: We 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. Methods: Postoperative 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. Results: Of 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). Conclusions: Increased 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. © 2023 Wiley Periodicals LLC. |
| Keywords: | adult; controlled study; human tissue; retrospective studies; major clinical study; sentinel lymph node biopsy; mastectomy; opiate; cohort analysis; breast neoplasms; breast reconstruction; mammaplasty; retrospective study; postoperative complication; postoperative complications; cancer center; body mass; narcotic analgesic agent; breast tumor; operation duration; antiemetic agent; breast endoprosthesis; breast implants; analgesics, opioid; postoperative pain; pain, postoperative; drug use; prophylactic mastectomy; ambulatory surgery; procedures; acute pain; humans; human; female; article; ambulatory breast surgery; postoperative opioid requirement; prophylactic versus therapeutic bilateral mastectomy with immediate tissue expander reconstruction; risk-reducing bilateral mastectomy |
| Journal Title: | Journal of Surgical Oncology |
| Volume: | 128 |
| Issue: | 5 |
| ISSN: | 0022-4790 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2023-10-01 |
| Start Page: | 719 |
| End Page: | 725 |
| Language: | English |
| DOI: | 10.1002/jso.27372 |
| PUBMED: | 37293694 |
| PROVIDER: | scopus |
| PMCID: | PMC10530122 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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