121. Postoperative Opioid Prescription Size and Patient-Reported Consumption Following Gender-Affirming Mastectomy

PURPOSE: Aligning opioid prescribing and consumption is critical to create guidelines that optimize postoperative pain management and minimize adverse events. Although prescribing guidelines exist for many surgical procedures, none exist for individuals undergoing gender-affirming procedures. We sought to describe opioid prescription patterns and consumption after gender-affirming mastectomies (GAM) as well as patient-reported pain and satisfaction. METHODS: Patients who underwent GAM between February 1, 2021 and September 30, 2021 at a tertiary care center were identified. Provision of a discharge opioid prescription was collected from the medical record, including opioid prescription size and number of refills. Analgesic use, patient-reported pain, and satisfaction with pain management were collected via telephone surveys 2-4 weeks postoperatively. This included the number of opioid pills consumed (standardized to 5-mg Oxycodone tablets) and use of non-opioid analgesics. In addition, average pain rating 1 week after surgery was reported on a 5-point Likert scale from “no pain” to “worst possible pain.” Satisfaction with pain management was rated on a 5-point scale with 1 representing “not satisfied at all” and 5 representing “very satisfied.” Differences in outcomes among individuals who consumed an opioid and those who did not consume an opioid were assessed using the chi-square or Fisher’s exact test, Mann-Whitney U test, and the Wilcoxon signed-rank test. RESULTS: A total of 115 patients met inclusion criteria and 88 responded to the survey (response rate = 77%). Of these 88 patients, 14 had incomplete opioid consumption data and 2 were not prescribed any opioids at discharge, leaving 72 patients eligible for analysis. Of these, 63 (87.5%) used opioids after surgery while 9 (12.5%) did not. Median (IQR) opioid prescription quantity was 15 (12-17) tablets and median (IQR) opioid consumption was 10 (3-14.5) tablets (p<0.0001). Most patients (63.4%) felt that their prescription size was “the right amount”, while 28.2% felt that the prescription amount was “too much” and 6.9% felt that the prescription amount was “too little.” Seventeen patients (23.6%) had their opioid prescription refilled, while 63.8% of patients reported consuming less opioids than prescribed. Additionally, 94.4% used non-opioid adjuncts like acetaminophen or ibuprofen. Finally, 100% of patients rated their satisfaction with postoperative pain management as a 4/5 or 5/5. CONCLUSION: In this cohort of individuals undergoing GAM, the majority of patients consumed fewer opioid medications than prescribed, and over a quarter of patients felt that they were prescribed too many opioids after surgery. The average opioid use was 10 pills, with a range of 3 to 15, suggesting that guidelines to direct postoperative prescribing should fall in this range. Finally, all patients reported that they were satisfied with their pain control and a vast majority utilized non-opioid adjuncts. Future work should focus on creating patient-centered guidelines that both align opioid prescribing with use and integrate opioid alternatives to optimize patients’ postoperative experience.