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Routine Opioid Prescriptions Are Not Necessary After Breast Excisional Biopsy or Lumpectomy Procedures

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Opioid analgesics are overprescribed after surgery. In August 2018, the authors replaced routine discharge opioid prescription with a nonsteroidal anti-inflammatory drug (NSAID) for patients who had a lumpectomy or excisional biopsy (lump/ex). This study compared patient-reported post-discharge pain scores for patients treated before and after the change in routine discharge medication.

Methods

Patients were categorized based on treatment before and after a change in discharge medication as follows: study period 1 (routine opioids), study period 2 (routine NSAID). Pain severity was assessed with an electronic survey on postoperative days (PODs) 1 to 5. Multivariable generalized estimating equations tested the association between pain severity and discharge in the first versus the second study period.

Results

Lump/ex was performed for 1606 patients between December 2017 and June 2019. Of these patients, 789 (49%) reported pain scores and were analyzed (328 in study period 1, 461 in study period 2). Opioid prescription at discharge decreased from 96% in period 1 to 14% (95% confidence interval [CI], 11–18%) in period 2. Only 1% of the patients discharged with NSAID were later prescribed an opioid. The maximum reported pain score on any POD for all the patients was severe for 30 patients (3.8%), moderate for 217 patients (28%), mild for 430 patients (54%), and none for 112 patients (14%). The estimated risk for moderate or greater pain on POD 1 was 36% for period 1 and 34% for period 2. The proportion of patients reporting moderate or greater pain was nonsignificantly lower for the patients treated in period 2 (odds ratio [OR], 0.91; 95% CI 0.67–1.22; P = 0.5).

Conclusions

For patients undergoing lump/ex, a clinically meaningful difference in reported post-discharge pain scores can be excluded with a change to routine NSAID at discharge. Patients undergoing lump/ex should not be routinely discharged with opioids.

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Acknowledgments

The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center, and by the Memorial Sloan Kettering Cancer Center Internal Diversity Enhancement Award.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Tracy-Ann Moo MD, Kimberly J. Van Zee MS, MD, Laurie J. Kirstein MD & Monica Morrow MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Melissa Assel MS & Andrew Vickers PhD

  3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Tracy-Ann Moo MD, Melissa Assel MS, Rubaya Yeahia BA, Ryan Nierstedt BS, Kimberly J. Van Zee MS, MD, Laurie J. Kirstein MD, Andrew Vickers PhD, Monica Morrow MD & Rebecca Twersky MD, MPH

  4. Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Rubaya Yeahia BA, Ryan Nierstedt BS & Rebecca Twersky MD, MPH

Authors
  1. Tracy-Ann Moo MD
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  2. Melissa Assel MS
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  3. Rubaya Yeahia BA
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  4. Ryan Nierstedt BS
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  5. Kimberly J. Van Zee MS, MD
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  6. Laurie J. Kirstein MD
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  8. Monica Morrow MD
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  9. Rebecca Twersky MD, MPH
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Corresponding author

Correspondence to Rebecca Twersky MD, MPH.

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Disclosure

Dr. Monica Morrow has received speaking honoraria from Genomic Health. The remaining authors have no conflicts of interest.

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Accepted for presentation in oral format at the Society of Surgical Oncology 2020 International Conference on Surgical Cancer Care.

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Moo, TA., Assel, M., Yeahia, R. et al. Routine Opioid Prescriptions Are Not Necessary After Breast Excisional Biopsy or Lumpectomy Procedures. Ann Surg Oncol 28, 303–309 (2021). https://doi.org/10.1245/s10434-020-08651-y

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  • DOI: https://doi.org/10.1245/s10434-020-08651-y

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