Arivoli Kumaran, Kim Gabriela J, Kenney Brooke, Haley Caleb, Lane Megan, Breuler Christopher, Morrison Shane D, Waljee Jennifer, Hsu Jessica J
From the University of Michigan Medical School, Ann Arbor, MI.
Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, MI.
Plast Reconstr Surg Glob Open. 2025 Aug 4;13(8):e7023. doi: 10.1097/GOX.0000000000007023. eCollection 2025 Aug.
Aligning opioid prescribing with patient needs is important for managing pain while minimizing risks. However, little is known about opioid prescribing after gender-affirming procedures. Given that gender-diverse patients are at higher risk for poor opioid-related outcomes, creating guidelines centered on patient-reported opioid use and pain experiences is critical. We conducted a prospective survey study examining opioid prescribing and consumption after gender-affirming mastectomy (GAM).
Patients who underwent GAM from February to September 2021 were identified. Electronic medical record data were collected, including opioid prescription and refill amounts. Patient-reported outcomes including opioid use, nonopioid adjunct use, pain rating 1 week postoperatively, and pain management satisfaction were collected via telephone surveys 2-4 weeks postoperatively. Descriptive statistics and bivariate analyses compared outcomes between opioid consumers and nonconsumers.
Of 115 patients, 72 responded with complete data (62.6% response rate). Sixty-three individuals (87.5%) consumed opioids and 9 (12.5%) did not consume opioids. The median (interquartile range) opioid prescription quantity was 15 (12-17) tablets. The median (interquartile range) consumption was 10 (3-14.5) tablets ( < 0.001). Most patients (63.4%) felt their prescription amount was appropriate, whereas 28.2% said it was too much. In all, 94.4% used nonopioid adjuncts, and 100% were satisfied with their postoperative pain management.
Most patients undergoing GAM reported using opioids, with an average of 10 pills, and were satisfied with their postoperative pain control. Going forward, surgeons should consider tailoring prescribing to patient needs and providing nonopioid alternatives when possible.
使阿片类药物处方与患者需求相匹配对于在将风险降至最低的同时管理疼痛至关重要。然而，对于性别确认手术后的阿片类药物处方情况知之甚少。鉴于性别多样化的患者出现阿片类药物相关不良后果的风险较高，制定以患者报告的阿片类药物使用情况和疼痛经历为中心的指南至关重要。我们进行了一项前瞻性调查研究，以检查性别确认乳房切除术后（GAM）的阿片类药物处方和使用情况。
确定了2021年2月至9月接受GAM的患者。收集电子病历数据，包括阿片类药物处方和再填充量。通过术后2 - 4周的电话调查收集患者报告的结果，包括阿片类药物使用情况、非阿片类辅助药物使用情况、术后1周的疼痛评分以及疼痛管理满意度。描述性统计和双变量分析比较了阿片类药物使用者和非使用者之间的结果。
115名患者中，72名提供了完整数据（应答率62.6%）。63人（87.5%）使用了阿片类药物，9人（12.5%）未使用阿片类药物。阿片类药物处方量的中位数（四分位间距）为15（12 - 17）片。消耗量的中位数（四分位间距）为10（3 - 14.5）片（<0.001）。大多数患者（63.4%）认为他们的处方量合适，而28.2%的患者表示处方量过多。总体而言，94.4%的患者使用了非阿片类辅助药物，100%的患者对术后疼痛管理感到满意。
大多数接受GAM的患者报告使用了阿片类药物，平均服用10片，并且对术后疼痛控制感到满意。未来，外科医生应考虑根据患者需求调整处方，并尽可能提供非阿片类替代药物。
