Opioid Prescribing Patterns after Body Contouring Surgery: A Retrospective Database Review

Goals/Purpose: The United States is currently experiencing the highest overdose death rate due to opioids in the nation’s history. Body contouring procedures include some of the most commonly performed elective procedures in plastic surgery. Misuse and addiction to opioids, including prescription pain relievers is a serious national crisis that affects public health as well as social and economic welfare. Our objective is to critically evaluate opioid use in body contouring surgery.

Methods/Technique: A commercially available database of 91 million unique patients, PearlDiver, was queried to identify patients who had undergone body contouring procedures between 2010 to 2020 using Common Procedural Terminology (CPT) codes. We identified patients that underwent panniculectomy, abdominoplasty, brachioplasty, thighplasty, mastopexy, breast augmentation, breast reduction and liposuction for analysis. We subsequently analyzed associated opioid use, and cost with specific focus on comorbid conditions and complications that result in prolonged or increased use of opioids.

Results/Complications: There was a total of 56,773 patients that underwent body contouring surgery. The most common opiate prescribed was hydrocodone with acetaminophen (37,017 patients). Average days of therapy was 17.92 days and average copay was $4.32. We reviewed the type of opiate prescribed with MME consumed and patients prescribed oxycodone consumed more. Comorbid conditions and post-operative complications were examined for risk of increased opioid use. Patients with peripheral vascular disease and smoking used significantly more morphine milliequivalents (MME) of opioids than patient without peripheral vascular disease (871.97 vs 535.41; p <0.001 and smoking (1069.57 vs 440.84; p <0.001). Patients who developed surgical site infection (1317.86 vs 543.51; p<0.001) , disruption of wound (1154.75 vs 552.80; p<0.001), and VTE (1213.63 vs 561.59; p<0.001) consumed a significantly higher MME of opioids. There were 1,173 patients undergoing body contouring procedures who were diagnosed with opioid dependence or abuse 90 days after surgery, and 202 patients that experienced an opioid overdose within 90 days after surgery.

Conclusion: This is the largest retrospective inquiry, to author’s knowledge, of opioid use amongst patients undergoing body contouring surgery. Responsible opiate use is integral, particularly in the setting of a global opiate crisis. The data provides relevant information on opiate use in the body contouring population, with critical assessment of the impact of comorbid conditions and postoperative complications on opiate use and can help guide plastic surgeons performing body contouring surgery regarding their opiate prescription habits.