Opioid Use Following Mastectomy: Does Surgical Indication Impact Use
Megan Lane, MD1, Shane D. Morrison, MD MS2, Gabriel O. Ramirez Rivera, BS3, Hsou-Mei Hu, PhD MBA MHS1, Caleb Haley, MD1, Christopher Breuler, MD1, Jennifer F. Waljee, MD MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Seattle Children's Hospital, Seattle, WA, USA, 3San Juan Batista School of Medicine, Caguas, PR, USA.
Purpose: Postoperative opioid prescribing patterns have a well-established association with opioid related harms. To date, few studies have explored postoperative prescribing patterns among transgender and nonbinary (TGNB) people, and little is known regarding how opioid prescribing may differ compared with cisgender individuals undergoing mastectomy. Methods: A retrospective cohort of TGNB patients who underwent mastectomy from 2010-2019 and a matched cisgender cohort who underwent mastectomy without reconstruction were created using claims drawn from the IBM Marketscan databases. Outcomes included initial prescription size, opioid refill 4-30 days postoperatively, and persistent opioid use, defined as >2 refills within 4-180 days postoperatively. Chi-square and Wilcoxon Rank-Sum testing was performed to compare cohorts. Multivariable logistic regression was used to examine characteristics associated with prolonged use and refill in the TGNB population. Results: Of 1,877 patients who underwent gender-affirming mastectomy and a matched cisgender cohort, TGNB patients were less likely to develop persistent use compared with cisgender patients (6.8% vs, 8.6%, p=0.05; Table 1), and less likely to refill opioids (22.4% vs. 30.8%, p <0.001). Previous opioid use was associated with increased prescription size, refills, and persistent use (Table 1). Conclusions: Compared to cisgender patients undergoing mastectomy, TGNB patients have lower rates of opioid refill and persistent use. Prior opioid exposure correlates with probability of refill and prolonged use.
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