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Institutional Experience with Variable Opioid Use for Gender Affirming Breast Surgery,
Oncological Mastectomy, and Mammoplasty
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Kortney Robinson MD, Sarah Duncan BA, Jasmine Austrie BA, Aaron Fleishman MPH, Gabriel Brat MD, MPH
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Introduction/Problem
Methods
Surgeons have struggled to effectively treat postoperative pain without putting patients at
undue risk of misuse and diversion from over-prescribing.
Recent studies have shown a broad range of opioid prescriptions for patients undergoing
surgeries with similar surgical exposure such as breast surgeries 1–3.
Determining best practices for prescribing may require identifying the demographic,
social, and medical characteristics that define use.
With projected rise in gender-affirming surgeries, accurate post-surgical prescribing for
top surgery is imperative.
In this study, we compare patient characteristics and prescribing practices in genderaffirming top surgery to two surgeries with similar surgical exposure.
October 2017-July 2018, patients undergoing mammoplasty reductions, gender affirmation
mastectomies (GAM), and oncologic mastectomies were enrolled in an IRB approved study.
Charts were reviewed for demographic, pre-operative mental health and substance misuse
history, peri-operative surgical data, and pre-operative psychoactive medications.
Phone call survey was conducted between 14- and 30-days post-discharge.
Patients were asked to count the remaining pills from their post-operative opioid
prescription. Total consumption was converted to morphine milligram equivalent (MME).
Aim/Goal
Identify differences in post-operative opioid prescribing and consumption.
Evaluate patient characteristics that impact opioid consumption and pain control.
The Team
Kortney Robinson, M.D., Surgery Resident, BIDMC
Sarah Duncan, BA Clinical Research Assistant II, FIRST Program
Jasmine Austrie, BA, Clinical Research Assistant II, FIRST Program
Michaela Carroll, BS, Clinical Research Coordinator, FIRST Program
Aaron Fleishman, M.P.H., Clinical Research Administrator, FIRST Program
Gabriel Brat, M.D., Acute Care Surgery, BIDMC
Results/Progress to Date
170 patients were
identified as opioid
naïve prior to surgery:
oncologic
mastectomy (N=25),
mammoplasty
reduction (N=79) and
gender affirming
mastectomy (N=65).
112 (66%) patients of
patients agreed to
participate in the
phone call study.
Patient
characteristics of the
three surgical groups
are listed in Table 1.
Table 1: Patient Demographics of patients undergoing each surgery
For more information, contact:
Kortney Robinson, M.D., krobins8@bidmc.harvard.edu
�Institutional Experience with Variable Opioid Use for Gender Affirming Breast Surgery,
Oncological Mastectomy, and Mammoplasty
Kortney Robinson MD, Sarah Duncan BA, Jasmine Austrie BA, Aaron Fleishman MPH, Gabriel Brat MD, MPH
Lessons Learned
More Results/Progress to Date
This data demonstrates that breast surgery patients were generally overprescribed
opioids, by a factor ranging between 2 and 5.
Data suggests that each surgical group has unique opioid requirements that may be
related to the specific demographic and health characteristics of the patients rather than
the surgical exposure.
Providers should not conflate mastectomy procedures without accounting for patient
characteristics.
Accurate prescribing based on patient profile is likely beneficial for improved pain control
and reduced future risk.
Limitations
Data is from a single academic center.
Survey data has inherent participation and recall bias.
Next Steps
Update surgical healthcare providers via surgery specific informational sessions about
opioid prescribing.
Collaborate with surgical providers who treat populations with known increased risk
factors with personalized support, multimodal pain management, early and often postoperative check-ins.
Figure 1: Amount of oxycodone prescribed verses consumed across the three breast surgeries
evaluated.
Oncologic mastectomy patients were prescribed significantly less opioid containing
medication than mammoplasty reduction or GAM patients.
GAM patients were prescribed significantly more opioid containing medications than
mammoplasty reduction patients (z<0.001), yet reported MME consumed was not
statistically different between mammoplasty reductions (z=0.512).
Over prescription (based upon unused pills) ranged from 80.2% in oncologic mastectomies
to 47.3% in mammoplasty reductions (Figure 1).
References:
1. Hill M V, Mcmahon ML, Stucke RS, Barth RJ. Wide Variation and Excessive Dosage of Opioid Prescriptions for
Common General Surgical Procedures. Ann Surg. 2016;265(4):1-6. doi:10.1097/SLA.0000000000001993
2. Nooromid MJ, Blay E, Holl JL, et al. Discharge prescription patterns of opioid and nonopioid analgesics after
common surgical procedures. Pain reports. 2018;3(1):e637. doi:10.1097/PR9.0000000000000637
3. Schreiber XL, Zinboonyahgoon X, Xu X, et al. Preoperative Psychosocial and Psychophysical Phenotypes as
Predictors of Acute Pain Outcomes After Breast Surgery. 2018. doi:10.1016/j.jpain.2018.11.004
For more information, contact:
Kortney Robinson, M.D., krobins8@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kortney Robinson (<a href="mailto:krobins8@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">krobins8@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kortney Robinson
Sarah Duncan
Jasmine Austrie
Michaela Carroll
Aaron Fleishman
Gabriel Brat
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Institutional Experience with Variable Opioid Use for Gender Affirming Breast Surgery, Oncological Mastectomy, and Mammoplasty
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety