Abstract P1-15-01: A brief intervention decreases opioid consumption following mastectomy with implant-based breast reconstruction
Authors: Egan Katie , Muenks Elizabeth , Nazir Niaman , De Souza Michelle , Korentager Richard 
Published: March 2020

Abstract
Purpose: Current rates of opioid prescribing and consumption in the United States have resulted in deleterious consequences for both patients and society. There has been a recent focus on opioid consumption and overprescribing, but little work has been done to evaluate the utility of patient education in opioid consumption. This study aimed to decrease opioid consumption in patients undergoing mastectomy and breast reconstruction through a patient education tool. Methods: Patients undergoing consultation for mastectomy and immediate, implant-based breast reconstruction between March, 2018 and January, 2019 were prospectively enrolled in a randomized control trial. Patients were randomized to standard of care or to receive a single-paged handout which included information on the pain scale, expectations for pain control, and examples of a multi-modal approach to pain control. A survey was administered at the preoperative and postoperative appointment to collect data on pain expectations and opioid use. A chart review was performed to obtain surgical information, patient comorbidities, and opioid prescription information. Results: Of 100 patients completing the preoperative survey, 97 patients (97.0%) underwent surgery and 85 patients (85.0%) completed the postoperative survey. Half of patients were randomized preoperatively to receive the intervention. Preoperatively, 27 patients (27.0%) had a history of a chronic pain syndrome, 34 (34.0%) of a mental health comorbidity, and 9 (9.0%) of both. Reconstruction was completed following bilateral mastectomy in 70.1% of patients (n=68) and unilateral mastectomy in 29.9% (n=29). A total of 85 tissue expander (87.6%) and 12 direct-to-implant (12.4%) reconstructions were completed. Patients were prescribed an average of 36.0 5mg-oxycodone tablets postoperatively. Patients in the intervention group consumed an average of 1/3 fewer opioids than patients in the control group (16.2 tablets, 121.5 MEE (SD=122.6) vs 24.3 tablets, 182.2 MEE (SD=181.9), p=0.03). Although not statistically significant, fewer patients in the intervention group required an opioid prescription refill (15.8% vs 21.7%). There was a trend towards lower pain scores in the intervention group (3.0/10 (SD=1.8) vs 3.6/10 (SD=1.6), p=0.06). Overall, patients reported consuming an average of 20.6 tablets postoperatively (154.5 MEE, SD=148.7), or 57.0% of the average prescription amount. The majority of patients (75.3%) reported taking an opioid less than once a day at the time of survey completion, and 24 patients (28.2%) reported that they had either not filled or had not used any of their opioid prescription postoperatively. Conclusions: Consistent with other studies of postoperative opioid consumption, patients undergoing mastectomy and implant-based breast reconstruction are prescribed nearly twice as many opioid tablets as consumed, and one in three patients report not using any opioids postoperatively. The amount of opioids prescribed in this population can be safely decreased. The results of this randomized controlled trial showed that through the use of a simple educational handout provided at a preoperative appointment, opioid consumption can be reduced by an additional 30% compared to patients receiving no intervention. Patients receiving an intervention are also less likely to require a refill. We recommend implementation of protocols related to opioid prescribing and the use of a simple educational tool to decrease opioid consumption among breast surgery patients.
Citation Format: Katie Egan, Elizabeth Muenks, Niaman Nazir, Michelle De Souza, Richard Korentager. A brief intervention decreases opioid consumption following mastectomy with implant-based breast reconstruction [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-15-01.