Acute pain after breast surgery and reconstruction: A two‐institution study of surgical factors influencing short‐term pain outcomes

Abstract

Background and ObjectivesAcute postoperative pain following surgery is known to be associated with chronic pain development and lower quality of life. We sought to analyze the relationship between differing breast cancer excisional procedures, reconstruction, and short‐term pain outcomes.MethodsWomen undergoing breast cancer excisional procedures with or without reconstruction at two systems: an academic hospital (AH) and Veterans Health Administration (VHA) were included. Average pain scores at the time of discharge and at 30‐day follow‐up were analyzed across demographic and clinical characteristics. Linear mixed effects modeling was used to assess the relationship between patient/clinical characteristics and interval pain scores with a random slope to account for differences in baseline pain.ResultsOur study included 1402 patients at AH and 1435 at VHA, of which 426 AH and 165 patients with VHA underwent reconstruction. Pain scores improved over time and were found to be highest at discharge. Time at discharge, 30‐day follow‐up, and preoperative opioid use were the strongest predictors of high pain scores. Younger age and longer length of stay were independently associated with worse pain scores.ConclusionsYounger age, preoperative opioid use, and longer length of stay were associated with higher levels of postoperative pain across both sites.

Prolonged Opioid Use Among Opioid-Naive Women Undergoing Breast Reconstructive Surgery

“…With regard to breast reconstruction, when comparing alloplastic (i.e., implantbased) and autologous (i.e., flap-based) reconstructions, implant-based reconstruction has been associated with higher pain levels and narcotic use in the postoperative hospitalization time period compared with autologous flap-based patients. 7,[15][16][17] Research has shown that higher levels of acute pain following breast reconstruction are associated with higher chronic pain levels and long-term analgesic consumption. 18,19 Marcusa et al 5 previously reported that 10% of opioid-naive women between 2010 and 2014 undergoing immediate breast reconstruction met the criteria for prolonged opioid use, and women with free flap reconstruction were less likely to use opioids at the 90day benchmark.…”

“…11,20 Breast surgery, especially breast reconstruction, has been associated with chronic pain and high rates of prolonged opioid use as over half of individuals using opioids at the 90-day mark are still using opioids after 5 years. 5,7,14,[17][18][19]21 Our study is particularly relevant given the resurgence of tissue expander placement surgeries; this could change the outcomes for the cohort of patients within the expander pool. Thus, this study aims to identify and compare autologous and alloplastic patients' risk for perioperative and prolonged opioid use following surgery.…”

“…4 Additionally, as 24% of patients opt to undergo immediate reconstruction within 4 months and reconstruction is associated with improved quality of life after breast cancer surgery, understanding the risks associated with opioid use following the procedures as they become increasingly popular is paramount. 7 8 9 10 11 This study aims to build upon previous work looking at opioid usage among patients undergoing mastectomy with reconstruction by comparing autologous and alloplastic reconstruction following mastectomy with regards to risk for perioperative and prolonged opioid use. The purpose of this study was to elucidate the factors that may lead to postoperative opioid use across both alloplastic and autologous patient populations.…”

Direct versus Ultrasound Guided PECS Block Effect on Controlling Postmastectomy Pain: A Randomized Single-Blind Trial

“…Surgery is typically the initial managment option for breast cancer (2) . Significant acute postoperative discomfort following breast surgery may develop into chronic pain (3) . The prolonged pain has serious physical and psychological effects on the lives of patients (4) .…”