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National Patterns of Post-Discharge Opioid Prescribing in Plastic and Reconstructive Surgery
Bashar M. Alsamman, B.A.1; Dany Y. Matar, B.A.1; John J. Lee, B.A.1,2; Taeyoung Park, B.A.1; Savo Bou Zein Eddine, M.D.3; Anahita Nimbalkar, B.S.1; Salih Colakoglu, M.D., Ph.D.1; Adriana C. Panayi, M.D., Ph.D.4; Gabriel Hundeshagen, M.D.5; Dennis P. Orgill, M.D., Ph.D.3 1 Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA 2 University of Virginia School of Medicine, Charlottesville, VA, USA 3 Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA 4 Department of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland 5 Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen 67071, Germany
Background: Procedure-specific post-discharge opioid prescribing in plastic and reconstructive surgery remains poorly defined nationally, particularly relative to patient-reported consumption. Methods: We performed a retrospective cohort study using the 2024 ACS-NSQIP dataset. Adults (≥18 years) undergoing plastic surgery with documented post-discharge opioid prescribing and postoperative length of stay ≤30 days were included. Procedures were grouped by CPT code and modeled as non–mutually exclusive components because episodes often included multiple concurrent codes. Multivariable logistic regression assessed demographic, perioperative, postoperative, and procedural associations with prescribing intensity. Prescribing was compared with published patient-reported consumption and consumption-based guidelines. Results: Among 30,903 patients, 21,513 (69.6%) received discharge opioid prescriptions. Mean daily morphine milligram equivalents was 39.7 (SD, 109.4), and mean duration was 3.6 days (SD, 2.2). High-intensity prescriptions (5.6%; n = 1,201) and renewals (4.2%; n = 909) were uncommon. Baseline differences were statistically significant but small (all Cramér’s V ≤ 0.19). After adjustment, mastectomy (aOR, 1.34; 95% CI, 1.22–1.48) and implant-based reconstruction (aOR, 1.20; 95% CI, 1.10–1.30) were associated with intermediate-intensity prescribing, whereas autologous flap procedures were associated with discharge without opioids (aOR, 1.52; 95% CI, 1.34–1.72; all p < 0.0001). The mean prescription, approximately 19.7 oxycodone 5 mg tablets over 3.6 days, exceeded published consumption across most domains. Gaps were narrowest after autologous flap and implant-based breast reconstruction and widest among ambulatory procedures. Conclusions: Prescribing remains discordant with consumption, particularly after ambulatory procedures. Enhanced recovery pathways may have narrowed gaps in breast reconstruction, while procedure-specific, consumption-based guidelines could improve opioid stewardship.
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