26. Opioid Prescribing Patterns among Plastic Surgery Residents for Bilateral Breast Reduction

Abstract

Background: Prescription opioid misuse in the United States accounts for significant avoidable morbidity and mortality. Surgeons are responsible for more than a third of opioid prescriptions. Although opioids continue to provide needed analgesia for surgical patients, there are only sporadic guidelines in the plastic surgery literature for their safe and appropriate use after surgery. The consequence is wide variability and excessive opioid prescriptions. Understanding patterns of prescribing among plastic surgery residents is an important step toward developing safer practice models for managing post-operative pain. Opioid prescribing patterns among plastic surgery residents remains unexplored. Methods: The authors performed a retrospective analysis of post-operative opioid prescriptions after bilateral breast reduction at a single academic medical center from 2018-2021. Single factor one-way ANOVA was used to evaluate prescribing patterns by resident, post-graduate year, attending of record, and patient characteristics (age, race, BMI, smoking status, diagnosis of chronic pain disorder, and mental health diagnosis). A multivariate analysis was performed to determine the degree to which these factors predicted opioid prescriptions. Results: A mean of 131 morphine milligram equivalents (MME) were prescribed by 12 residents for the 126 patients who underwent bilateral breast reductions included in this study. This is over four times the MMEs typically used by patients after this operation. Significant variability in prescribing among residents (p<0.001) was found irrespective of patient characteristics. Additionally, opioid prescriptions were found to differ based on attending (p value< 0.001). However, a multivariate analysis performed based on the variables for the initial ANOVA analyses found that only resident post-graduate year (p<0.001) and resident prescriber (p<0.001) were significant predictors of opioid prescriptions. Conclusion: There is wide variability in plastic surgery resident prescribing after bilateral breast reduction surgery. These prescriptions are often in excess of typical consumption after this operation. Findings highlight residents as a promising target for transforming opioid prescribing, as they were found to be the main predictor of opioid prescriptions after surgery. Thus, overall opioid prescribing can be drastically changed by improving the education of residents and facilitating their decision-making by implementing evidence-based, opioid-conscious analgesic protocols after common plastic surgery operations.