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Changing the Default: A Prospective Study of Reducing Discharge Opioid Prescription after Lumpectomy and Sentinel Node Biopsy

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

Abstract

Background

Whether routinely prescribed opioids are necessary for pain control after discharge among lumpectomy/sentinel node biopsy (Lump/SLNB) patients is unclear. We hypothesize that Lump/SLNB patients could be discharged without opioids, with a failure rate < 10%. This study prospectively examines outcomes after changing standard discharge prescription from an opioid/non-steroidal anti-inflammatory drug (NSAID) to NSAID/acetaminophen.

Patients and Methods

Standard discharge pain medication orders included opioids in the first 3-month study period and were changed to NSAID/acetaminophen in the second 3-month period. Patient-reported medication consumption and pain scores were collected by post-discharge survey. Frequency of discharge with opioid, NSAID/acetaminophen failure rate, opioid use, and pain scores were examined.

Results

From May to October 2019, 663 patients had Lump/SLNB: 371 in the opioid study period and 292 in the NSAID period. In the opioid period, 92% (342/371) of patients were prescribed an opioid at discharge; of 142 patients who documented opioid use on the survey, 86 (61%) used zero tablets. Among 56 (39%) patients who used opioids, the median number taken by POD 5 was 4. After the change to NSAID/acetaminophen, rates of opioid prescription decreased to 14% (41/292). The NSAID/acetaminophen failure rate was 2% (5/251). Among survey respondents, there was no significant difference in the maximum reported pain scores (POD 1–5) between the opioid period and the NSAID period (p = 0.7).

Conclusions

In Lump/SLNB patients, a change to default discharge with NSAID/acetaminophen resulted in a 78% absolute reduction in opioid prescription, with a failure rate of 2% and no difference in patient-reported pain scores. Most Lump/SLNB patients can be discharged with NSAID/acetaminophen.

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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. Dr. Monica Morrow has received honoraria from Genomic Health. Dr. Andrea V. Barrio has received honoraria from Roche. All other authors have no conflicts of interest to disclose. This study has been accepted for presentation in oral format at the 2020 American Society of Breast Surgeons 21st Annual Meeting.

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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, Kate R. Pawloski MD, Jillian Charyn BA, Lisa M. Sclafani MD, George Plitas MD, Andrea V. Barrio MD, Laurie J. Kirstein MD, Kimberly J. Van Zee MS, MD & Monica Morrow MD

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

    Varadan Sevilimedu MBBS, DrPH

  3. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Brett A. Simon MD, PhD

  4. Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Brett A. Simon MD, PhD

Authors
  1. Tracy-Ann Moo MD
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  2. Kate R. Pawloski MD
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  3. Varadan Sevilimedu MBBS, DrPH
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  4. Jillian Charyn BA
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  5. Brett A. Simon MD, PhD
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  6. Lisa M. Sclafani MD
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  7. George Plitas MD
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  8. Andrea V. Barrio MD
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  9. Laurie J. Kirstein MD
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  10. Kimberly J. Van Zee MS, MD
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  11. Monica Morrow MD
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Corresponding author

Correspondence to Monica Morrow MD.

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Moo, TA., Pawloski, K.R., Sevilimedu, V. et al. Changing the Default: A Prospective Study of Reducing Discharge Opioid Prescription after Lumpectomy and Sentinel Node Biopsy. Ann Surg Oncol 27, 4637–4642 (2020). https://doi.org/10.1245/s10434-020-08886-9

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  • DOI: https://doi.org/10.1245/s10434-020-08886-9

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