Opioid Consumption After Gender-Affirming Mastectomy and Two Other Breast Surgeries

Robinson, Kortney; Duncan, Sarah; Austrie, Jasmine; Fleishman, Aaron; Tobias, Adam M.; Hopwood, Ruben; Brat, Gabriel

doi:10.1016/j.jss.2019.12.043

Cited by 13 publications

(13 citation statements)

References 11 publications

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“…Nonetheless, we chose to use our telephone-based consumption data as a reference for comparison since it is a commonly used method for collecting opioid consumption data in prior studies, had a high response rate of 60% in our study, and its accuracy has been validated by previous work demonstrating that it aligns closely with in-person based consumption estimates. 8,9,11,12 While our SMS-based survey had a comparatively lower response rate as expected, 18,39,40 the automated nature of this survey method may limit recall bias. We were able to automatically contact patients on a weekly basis after discharge, while studies using telephone and other labor-intensive survey methods have waited up to 12 months after discharge to survey patients on their pain and opioid consumption after surgery.…”

Section: Limitationsmentioning

confidence: 63%

“…8 This survey had an excellent response rate and the accuracy of such telephone-based post-surgical opioid consumption surveys has been validated elsewhere. 8,9 The consumption data it produced proved useful in guiding many institutional prescribing protocols and in evaluating the validity of existing guidelines and prescribing practices. 2,8,10 However, the telephone-based method of data collection was not easy to scale to include additional procedures or institutions without a concomitant increase in staffing.…”

Section: Introductionmentioning

confidence: 96%

“…This involved research staff members calling patients following discharge to inquire about opioid consumption. 8 This survey had an excellent response rate and the accuracy of such telephone-based post-surgical opioid consumption surveys has been validated elsewhere. 8,9 The consumption data it produced proved useful in guiding many institutional prescribing protocols and in evaluating the validity of existing guidelines and prescribing practices.…”

Section: Introductionmentioning

confidence: 96%

“…8,9 The consumption data it produced proved useful in guiding many institutional prescribing protocols and in evaluating the validity of existing guidelines and prescribing practices. 2,8,10 However, the telephone-based method of data collection was not easy to scale to include additional procedures or institutions without a concomitant increase in staffing. In an effort to reduce the manual component of data collection, we developed a new, automated method of data collection.…”

Section: Introductionmentioning

confidence: 99%

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Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

Kennedy

et al. 2021

Preprint

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Background: Post-discharge opioid consumption is an important source of data in guiding appropriate opioid prescribing guidelines, but its collection is tedious and requires significant resources. Furthermore, the reliability of post-discharge opioid consumption surveys is unclear. Our group developed an automated short messaging service (SMS)-to-web survey for collecting this data from patients. In this study, we assessed its effectiveness in estimating opioid consumption by performing causal adjustment and comparison to a phone-based survey as reference. Methods: Patients who underwent surgical procedures at our institution from 2019-2020 were sent an SMS message with a link to a secure web survey to quantify opioids consumed after discharge. Several patient factors extracted from the EHR were tested for association with survey response. Following targeted learning (TL) nonresponse adjustment using these EHR-based factors, opioid consumption survey results were compared to a prior telephone-based survey at our institution as a reference. Results: 6,553 patients were included. Opioid consumption was measured in 2,883 (44%), including 1,342 (20.5%) through survey response. Characteristics associated with inability to measure opioid consumption included age, length of stay, race, tobacco use, and missing preoperative assessment. Among the top 10 procedures by volume, EHR-based TL nonresponse bias adjustment corrected the median opioid consumption reported by an average of 57%, and corrected the 75th percentile of reported consumption by an average of 11%. This brought median estimates for 6/10 procedures closer to telephone survey-based consumption estimates, and 75th percentile estimates for 3/10 procedures closer to telephone survey-based consumption estimates. Conclusion: We found that applying electronic health record (EHR)-based machine learning nonresponse bias adjustment is essential for debiased opioid consumption estimates from patient surveys. After adjustment, post-discharge surveys can generate reliable opioid consumption estimates. Clinical factors from the EHR combined with TL adjustment appropriately capture differences between responders and nonresponders and should be used prior to generalizing or applying opioid consumption estimates to patient care.

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Section: Limitationsmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

Kennedy

et al. 2021

Preprint

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“…Details for each survey protocol are available in published reports. 9,16,17 Data were extracted from the electronic medical record system at each institution followed by a phone survey at 2 hospital systems or an in-person survey at the third hospital system within 35 days after discharge. Patients were asked to count remaining pills from their opioid prescriptions.…”

Section: Methodsmentioning

confidence: 99%

Comparing Clinician Consensus Recommendations to Patient-reported Opioid Use Across Multiple Hospital Systems

et al. 2020

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Objective: We compare consensus recommendations for 5 surgical procedures to prospectively collected patient consumption data. To address local variation, we combined data from multiple hospitals across the country. Summary of Background Data: One approach to address the opioid epidemic has been to create prescribing consensus reports for common surgical procedures. However, it is unclear how these guidelines compare to patientreported data from multiple hospital systems. Methods: Prospective observational studies of surgery patients were completed between 3/2017 and 12/2018. Data were collected utilizing postdischarge surveys and chart reviews from 5 hospitals (representing 3 hospital systems) in 5 states across the USA. Prescribing recommendations for 5 common surgical procedures identified in 2 recent consensus reports were compared to the prospectively collected aggregated data. Surgeries included: laparoscopic cholecystectomy, open inguinal hernia repair, laparoscopic inguinal hernia repair, partial mastectomy without sentinel lymph node biopsy, and partial mastectomy with sentinel lymph node biopsy. Results: Eight hundred forty-seven opioid-naı ¨ve patients who underwent 1 of the 5 studied procedures reported counts of unused opioid pills after discharge. Forty-one percent did not take any opioid medications, and across all surgeries, the median consumption was 3 5 mg oxycodone pills or less. Generally, consensus reports recommended opioid quantities that were greater than the 75th percentile of consumption, and for 2 procedures, recommendations exceeded the 90th percentile of consumption. Conclusions: Although consensus recommendations were an important first step to address opioid prescribing, our data suggests that following these recommendations would result in 47%-56% of pills prescribed remaining unused. Future multi-institutional efforts should be directed toward refining and personalizing prescribing recommendations.

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Global Epidemiology and Social-Ecological Determinants of Substance Use Disparities, Consequences of Use, and Treatment Options Among Sexual and Gender Minority Populations

Mimiaga,

Klasko-Foster,

Santostefano

et al. 2024

Global LGBTQ Health

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Across the globe, sexual and gender minority populations experience stressors (e.g., stigma, discrimination, violence) at the individual, interpersonal, and environmental levels that may increase their risk of substance use and substance use disorders compared to their heterosexual and cisgender peers. This chapter describes the scope of disparities in substance use and related deleterious health outcomes for sexual and gender minority individuals from a global perspective. We give a brief overview of substances and their common classifications to provide context for how each may affect sexual and gender minority populations. Next, we review epidemiology of substance use and addiction across regions, with attention to cultural context. We emphasize disproportionate burden of substance use and resultant disease in sexual and gender minority individuals compared to both sexual majority groups and the general population in each of these geographic areas. In addition, we examine substance use and misuse specific to categories of sexual and gender minorities (e.g., gay men, transgender women) as well as racial/ethnic disparities within sexual and gender minority groups. We then discuss both risk and protective factors that may contribute to disparities in substance use and misuse for sexual and gender minority groups from a social-ecological perspective. Next, we describe consequences of substance use, specific to sexual and gender minority populations, including physical health outcomes (i.e., infectious and chronic diseases), social isolation, and incarceration. Lastly, we conclude this chapter with a review of substance use interventions specific to sexual and gender minorities.

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Opioid Consumption After Gender-Affirming Mastectomy and Two Other Breast Surgeries

Cited by 13 publications

References 11 publications

Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

Comparing Clinician Consensus Recommendations to Patient-reported Opioid Use Across Multiple Hospital Systems

Global Epidemiology and Social-Ecological Determinants of Substance Use Disparities, Consequences of Use, and Treatment Options Among Sexual and Gender Minority Populations

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