Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2021 Nov;28(12):7823-7833. doi: 10.1245/s10434-021-10023-z. Epub 2021 May 6.
The response to the unprecedented opioid crisis in the US has increased focus on multimodal pain regimens and enhanced recovery after surgery (ERAS) pathways to reduce opioid use. This study aimed to define patient and system-level factors related to perioperative consumption of opioids in autologous free-flap breast reconstruction.
We conducted a retrospective study to identify patients who underwent autologous breast reconstruction between 2010 and 2016. A multivariate linear regression model was developed to assess patient and system-level factors influencing opioid consumption. Opioid consumption was then dichotomized as total postoperative opioid consumption above (high) and below (low) the 50th percentile to afford more in-depth interpretation of the regression analysis. Secondary outcome analyses examined postoperative complications and health-related quality-of-life outcomes using the BREAST-Q.
Overall, 601 patients were included in the analysis. Unilateral reconstruction, lower body mass index, older age, and administration of ketorolac and liposomal bupivacaine were associated with lower postoperative opioid consumption. In contrast, history of psychiatric diagnoses was associated with higher postoperative opioid consumption. There was no difference in the rates of postoperative complications when comparing the groups, although patients who had lower postoperative opioid consumption had higher BREAST-Q physical well-being scores.
System-level components of ERAS pathways may reduce opioid use following autologous breast reconstruction, but surgical and patient factors may increase opioid requirements in certain patients. ERAS programs including liposomal bupivacaine and ketorolac should be established on a system level in conjunction with continued focus on individualized care, particularly for patients at risk for high opioid consumption.
美国空前的阿片类药物危机促使人们更加关注多模式疼痛管理方案和术后加速康复（ERAS）路径，以减少阿片类药物的使用。本研究旨在确定与自体游离皮瓣乳房重建围手术期阿片类药物使用相关的患者和系统水平因素。
我们进行了一项回顾性研究，以确定 2010 年至 2016 年间接受自体乳房重建的患者。建立了多变量线性回归模型，以评估影响阿片类药物消耗的患者和系统水平因素。然后将阿片类药物消耗分为总术后阿片类药物消耗高于（高）和低于（低）第 50 百分位，以便更深入地解释回归分析。使用 BREAST-Q 进行了二次结果分析，以检查术后并发症和健康相关生活质量结局。
总体而言，纳入了 601 名患者进行分析。单侧重建、较低的体重指数、年龄较大、使用酮咯酸和脂质体布比卡因与较低的术后阿片类药物消耗相关。相比之下，有精神科诊断史与较高的术后阿片类药物消耗相关。在比较两组的术后并发症发生率时，没有差异，尽管术后阿片类药物消耗较低的患者的 BREAST-Q 身体整体健康评分较高。
ERAS 路径的系统水平组成部分可能会减少自体乳房重建后的阿片类药物使用，但手术和患者因素可能会增加某些患者对阿片类药物的需求。应在系统层面上建立包括脂质体布比卡因和酮咯酸的 ERAS 方案，并持续关注个体化护理，特别是对于高阿片类药物消耗风险的患者。
