A significant percentage of patients who undergo plastic and reconstructive surgery have persistent or prolonged opioid use, according to a study published in JAMA Facial Plastic Surgery.

To evaluate the prevalence of immediate and long-term opioid use after several plastic and reconstructive surgical procedures, researchers followed 466,677 patients (average age, 46.8 years) who underwent nasal, eye, breast, abdomen, or soft tissue reconstruction surgery between January 2007 and December 2015. The investigators assessed the rates of persistent opioid use (ie, prescriptions filled 90 to 180 days after surgery) and prolonged opioid use (ie, prescriptions filled 90 to 180 and 181 to 365 days after surgery).

A total of 49.7% patients filled prescriptions for postoperative analgesics, 91.5% of which were for opioids. Patients who underwent breast and nasal procedures accounted for 60.8% and 65.7%, respectively, of these perioperative opioid prescriptions.

Among patients who filled perioperative opioid prescriptions, 10% and 2.5% had persistent and prolonged opioid use, respectively. Among patients who did not fill a perioperative prescription, only 3.8% and 1.2% had persistent and prolonged opioid use, respectively.

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Patients who filled perioperative opioid prescriptions were more likely to display persistent or prolonged opioid use (odds ratio, 2.87 and 2.90, respectively). Patients who underwent breast and nasal procedures had the greatest odds for persistent use (odds ratio, 4.36 and 3.51, respectively). Independent risk factors for persistent or prolonged opioid use postoperatively included perioperative opioid use, procedure type, and prior-year mental health and substance abuse diagnoses.

Study limitations include the absence of data on opioids obtained from nonmedical sources.

“Given the significant risk [for] persistent opioid use after plastic and reconstructive procedures, it is imperative to develop best practices guidelines for postoperative opioid prescription practices in this population,” concluded the study authors.

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Reference

Olds C, Spataro E, Li K, Kandathil C, Most SP. Assessment of persistent and prolonged postoperative opioid use among patients undergoing plastic and reconstructive surgery[published online March 7, 2019]. JAMA Facial Plast Surg. doi:10.1001/jamafacial.2018.2035