P73: How much does postoperative pain interfere with activities of daily living after breast surgery?

Thursday, March 23, 2023

3:41 PM – 3:46 PM

Location: SSO HUB: Rare/Metastatic Cancers Zone

Poster Presenter(s)

Kate R. Pawloski, MD, MPH (she/her/hers)

General Surgery Resident
Icahn School of Medicine at Mount Sinai
NEW YORK CITY, New York, United States

Disclosure information not submitted.

Author(s)

Kate R. Pawloski, MD, MPH (she/her/hers)

General Surgery Resident
Icahn School of Medicine at Mount Sinai
NEW YORK CITY, New York, United States

Disclosure information not submitted.
SH

Su Hnin, BS

Medical Student
SUNY Downstate Medical School, United States

Disclosure information not submitted.
HK

Hannah Kalvin, MSPH

Assistant Research Biostatistician
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
VS

Varadan Sevilimedu, MBBS, DrPH

Biostatistics Service, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
TL

Tiana Le, BS

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Audree Tadros, MD MPH

Assistant Attending
Memorial Sloan Kettering Cancer Center
New York, NY, United States

Disclosure information not submitted.
Laurie J. Kirstein, MD

Attending Surgeon
Memorial Sloan Kettering Cancer Center
middletown, NJ, United States

Disclosure information not submitted.
Monica Morrow, MD, FACS

Chief, Breast Surgical Service; Anne Burnet Windfohr Chair of Clinical Oncology, Memorial Sloan Kettering Cancer Center; Professor of Surgery Weill Cornell Medical College
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure(s): No financial relationships to disclose
Tracy-Ann Moo, MD

Associate Attending Surgeon
Memorial Sloan Kettering Cancer Center
New York, NY, United States

Disclosure information not submitted.

Disclosure(s):

Monica Morrow, MD, FACS: No financial relationships to disclose

Introduction: Over 30% of patients report moderate-severe pain after breast surgery. The degree to which postoperative pain interferes with activities of daily living (ADLs) is not well-characterized. We examined the effect of pain on interference with ADLs and analgesic use in lumpectomy and sentinel lymph node biopsy (L-SLNB) and mastectomy patients with and without axillary surgery (Mx).

Methods: We retrospectively identified consecutive L-SLNB and Mx patients from 1/2019-12/2020 who completed ≥1 post-discharge survey on postoperative days (POD) 1-5 (L-SLNB) and POD 1-10 (Mx). The highest pain score was used to categorized patients as having none-mild or moderate-severe pain. Interference was reported as none/a little, somewhat, and quite a bit/very much. Patient-reported data was compared using Wilcoxon rank-sum and chi-square tests. Generalized estimating equations with a logit link were used to assess the change in interference over time.

Results: Overall, 1067 patients underwent L-SLNB and 1219 Mx; 436 (41%) and 857 (70%) patients reported moderate-severe pain. Among L-SLNB and Mx patients with moderate-severe pain, 190 (44%) and 121 (14%) rated interference as none/a little, 178 (41%) and 341 (40%) as somewhat, and 68 (16%) and 395 (46%) as quite a bit/very much. Patients with moderate-severe pain were more likely to report quite a bit/very much interference compared to those with none-mild pain (L-SLNB: 16% vs 1.1%; Mx: 46% vs 3.8%; p < 0.001 for both). Interference decreased over time in L-SLNB and Mx patients (Figure). Interference decreased on POD 2-5 in L-SLNB and 2-10 in Mx patients compared with POD 1 (p < 0.001 for each day). Overall, patients who reported any interference took more opioids (L-SLNB: median 1 vs. 0 pills, p</em>=0.001; Mx: median 2 vs. 0 pills, p < 0.001) and non-opioid analgesics (L-SLNB: median 6 vs. 5 pills, p=0.005; Mx: median 14 vs. 9 pills, p=0.002) compared to those with no reported interference.

Conclusions: Patients with moderate-severe pain were more likely to report interference with ADLs independent of surgery type, but interference decreased over time. Opioid use was low despite higher reported interference in patients with moderate-severe pain, supporting avoidance of routine opioids. Our findings can be used to inform preoperative counseling on return to normal activity after breast surgery.
Learning Objectives:
Upon completion, participants will be able to describe the degree to which acute postoperative pain interferes with activities of daily living after breast oncologic surgery.
Upon completion, participants will be able to describe how interference with activities of daily living changes over time in patients undergoing breast oncologic surgery.
Upon completion, participants will be able to describe the quantity of post-discharge opioid and non-opioid pills taken by patients who report interference with activities of daily living after breast surgery.