Recent preoperative opioid prescription is associated with increased complications after microsurgical breast reconstruction.

Abstract

Opioids are frequently prescribed during breast cancer treatment, resulting in patients presenting with recent opioid exposure for microsurgical breast reconstruction (MBR). However, the effect of preoperative opioid use on postoperative outcomes following MBR remains poorly defined. We evaluated whether recent opioid exposure is associated with increased postoperative complications and healthcare utilization after MBR. In this retrospective cohort analysis using the TriNetX national database, adult female patients who underwent MBR (2010-2025) were identified and 1:1 propensity score matching was performed. These patients were then divided into two groups: matched opioid use and matched non-opioid use groups. Primary outcomes were 30-day complications (wound dehiscence, surgical site infection [SSI], sepsis, urinary tract infection [UTI], and pulmonary embolism [PE]). Secondary outcomes were 30-day hospital readmission and emergency department (ED) visits, and reoperation within 1 year. The Pearson chi-squared test or Fisher's exact test and t-test were used to compare the cohorts, and multivariable regression analysis was conducted for each outcome to calculate risk ratios (RRs). Statistical significance was set at p<0.05. Among the 23,471 patients, 3780 in the opioid use group were matched to 3780 non-opioid use controls. The opioid use group had higher 30-day complication rates: wound dehiscence (RR 1.37, p=0.006), SSI (RR 1.35, p=0.008), sepsis (RR 1.59, p=0.040), UTI (RR 2.04, p=0.040), and PE (RR 2.24, p=0.013). Healthcare utilization was greater among the opioid users, with increased readmissions (RR 1.25, p=0.036), ED visits (RR 1.57, p<0.001), and reoperations (RR 1.29, p<0.001). Recent preoperative use of opioids is a significant risk factor for early and late complications following MBR.