V62: Breaking the Pain Cycle: The Impact of Enhanced Recovery Protocols Following Mastectomy on Long-term Opioid and Sedative Use

Introduction: Enhanced Recovery After Surgery (ERAS) protocols following mastectomy with or without implant-based reconstruction (IBR) are associated with decreased length of stay, postoperative pain, & discharge opioid requirements. However, less is known about the protocols’ effect on long-term opioid & sedative use.


Methods: A retrospective review of all mastectomy patients at a single institution with or without IBR between January 2013 and December 2019 was performed. The protocol, implemented in February 2017, divided patients into two groups: pre-ERAS and ERAS. Chronic opioid & sedative use was defined as requiring opioid/sedative prescriptions beyond 90 days post-surgery. We used Chi-square to compare groups’ baseline characteristics and prevalence of chronic opioid and sedative use, and univariable and multivariable logistic regression to compare odds of chronic opioid and sedative use.


Results: 756 patients met inclusion criteria: 405 pre-ERAS® and 351 ERAS. The groups had similar proportions of opioid-naïve patients. The ERAS group was younger (55.1 vs 57.3 y, p=0.03), less likely to smoke, (1% vs 4%, p=.016), or have diabetes (5% vs 9%, p=.014). The ERAS group was more likely to have an axillary procedure with mastectomy (86% vs 81%, p< .001), single-stage reconstruction (80% vs 67%, p=.004) with subcutaneous implant (49% vs 14%, p< .001), and an active anxiolytic or sedative prescription at surgery (45% vs 37%, p=.038). Post-ERAS, chronic opioid use decreased in opioid-naïve (40% vs 30%, p=0.024) and opioid tolerant patients (58% vs 37%, p=0.002), with no increase in chronic sedative use. There were decreased odds of chronic opioid use for all ERAS® patients (OR=0.57, p< .001), and of IBR patients, those receiving subcutaneous implants (OR=0.31, p< .001). There was increased chronic opioid use if undergoing bilateral surgery (OR=1.54, p=.005), two-stage reconstruction (OR=9.78, p< .001), and for patients with higher PACU pain scores (OR=1.09, p=.002) or >150 discharge OMEs (OR=2.63, p< .001).


Conclusions:

ERAS protocols for mastectomy patients with or without IBR are associated with decreases in chronic opioid use, without concomitant increases in chronic sedative use.