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Comment & Response
August 22, 2019

Confounding Factors on Postoperative Use Following Plastic and Reconstructive Surgery—Reply

Author Affiliations
  • 1Washington University School of Medicine in St Louis, Missouri
  • 2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
JAMA Facial Plast Surg. 2019;21(5):465-466. doi:10.1001/jamafacial.2019.0761

In Reply Thank you, Dr Pisano, for your insightful comments regarding our recent article. It is true that large analyses such as this should be examined critically and with an understanding of the limitations of large data sets. Regarding surgery duration, we did not adjust the analysis by surgery duration or use of regional blocks. While these could potentially be confounding factors related to pain in the immediate postoperative period and use of opioids, they would be unlikely to contribute to prolonged opioid use, which was the primary outcome analyzed in this study. Additionally, this level of detail for each procedure is difficult to obtain from a large database and often may be inaccurate or, more commonly, incomplete. Finally, the anesthesia literature has examined factors leading to increased postoperative pain. In a systematic review of the literature, preexisting pain, anxiety (or other psychological distress), age, and type of surgery were the most significant predictors for postoperative pain, while type of surgery, age, and psychological issues were the most significant predictors of postoperative analgesic consumption.1 Regarding use of nonopioid drugs/methods for control of pain, we are actively involved in this area and hope to report on it in the near future.