Risk Factors of Persistent Opioid Use After Forehead Flap Reconstruction

Abstract

Purpose:

To assess the risk of persistent opioid use after forehead flaps with preserved vascular pedicles.

Materials and methods:

This multi-center cohort study used the TriNetX, LLC US Collaborative Network to identify patients undergoing forehead flaps with preservation of the vascular pedicle. Patients were grouped based on whether they received an opioid prescription within 1 week of surgery. Propensity matching controlled for age, race, sex, pain diagnoses, and previous opioid use. Baseline characteristics were analyzed with t-tests and chi-squares. Risk ratios assessed associations between variables and development of new persistent opioid use (new opioid prescription 3-9 months after forehead flap reconstruction).

Results:

Overall, 7214 patients (3280 female [45.5%]) underwent forehead flap reconstruction with preservation of the vascular pedicle and 2660 (36.9%) receive a postoperative opioid prescription. Unadjusted analysis demonstrated a statistically significant association between gender and receipt of a postoperative opioid prescription, with male patients more likely than female patients to receive an opioid prescription (χ² = 14.94, P < .001). After propensity score matching, 1352 patients (588 women [43.3%]) with a mean (SD) age of 67.3 (14.7) years, were included for analysis. Patients who receive a postoperative opioid prescription were at 3.21 times greater risk of developing new persistent opioid use compared to patients not prescribed postoperative opioids (RR = 3.21; 95% CI (2.27, 4.52)).

Conclusions:

Patients who receive postoperative opioid prescriptions after forehead flap reconstruction may be at greater risk of developing new persistent opioid use.