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Background: Opioid dependence can occur in 6% to 10% of patients undergoing breast reconstruction. With the expansion of interdisciplinary initiatives to decrease opioid use after surgery, an updated look at the incidence of and risk factors for prolonged opioid dependence after free flap breast reconstruction is essential. Methods: We retrospectively identified all cases of free flap breast reconstruction completed at our institution from 2017 to 2020. Patients undergoing additional surgery within 120 days of the free flap procedure were excluded. Postoperative opioid prescriptions were identified; prolonged opioid use was defined as the receipt of additional prescriptions 91 to 120 days after surgery. Demographic and perioperative variables were assessed for their relationship with prolonged opioid use by logistic regressions. Results: A total of 732 patients were included in the final analysis; of these, 15 patients (2%) received additional opioid prescriptions 91 to 120 days after surgery (ie, had prolonged opioid use). Univariable associations were identified between prolonged opioid use and intraoperative morphine milliequivalents (OR = 2.3 per 50 units [95% CI, 1.5-3.5]; P  < .001), opioid prescriptions 31 to 60 days after surgery (OR = 16.1 [95% CI, 4.0-65.0]; P  < .001) and 61 to 90 days after surgery (OR = 89.4 [95% CI, 13.7-584.5]; P  < .001), and history of substance use disorder (OR = 8.3 [95% CI, 2.2-31.6]; P  = .002), anxiety (OR = 3.8 [95% CI, 1.2-12.1]; P  = .023), or mood disorder (OR = 12.7 [95% CI, 1.3-121.3]; P  = .027). Conclusion: In our cohort, 2% of patients who underwent autologous breast reconstruction (15/732) had prolonged opioid use. The currently used perioperative opioid minimization initiatives may benefit patients undergoing autologous breast reconstruction., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2023 The Author(s).)

Background: Surgical site infections (SSIs) are a major driver of morbidity after combined liver and colorectal surgery for metastatic colorectal cancer. Available literature is inadequate to characterize risk factors and benchmarks for quality improvement., Methods: Consecutive cases of simultaneous liver and colorectal surgery for colorectal adenocarcinoma from November 2013 through September 2022 were reviewed for SSIs per National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) criteria. Univariable and multivariable logistic regression evaluated associations with NSQIP 30-day organ-space SSIs., Results: In 580 procedures, the rate of 30-day organ-space SSIs was 16% (n = 94) using NSQIP criteria and 11% (n = 64) using NHSN criteria; 4% (n = 24) had incisional SSIs by both criteria. Most organ-space SSIs were perihepatic, and a minority were associated with bile (26%) or anastomotic (15%) leak. Independent risk factors for organ-space SSIs included major liver resection, upper abdominal (compared with lower abdominal/pelvic) colorectal procedure, and ostomy reversal. Organ-space SSI rates increased over time by approximately 16% per calendar year (p = 0.02) despite a declining rate of major liver resection; incisional SSI rates remained low. Overall, major morbidity was 22%, with 7-day median length of stay (interquartile range 6-9) and 0.3% 90-day mortality., Conclusion: Organ-space SSIs are a significant driver of postoperative morbidity in simultaneous liver and colorectal resections for metastatic colorectal adenocarcinoma. Our findings confirm simultaneous resection remains safe and interventions to mitigate the risk of perihepatic organ-space SSIs in high-risk patients are warranted., Competing Interests: Disclosure. Lauren E. Schleimer, Lynn Hakki, Kenneth Seier, Susan K. Seo, Nina Cohen, Shauna Usiak, Tiffany Romero, Mini Kamboj, Crisanta Ilagan, Lily V. Saadat, Remo Alessandris, Kevin C. Soares, Maria Widmar, Iris H. Wei, Emmanouil P. Pappou, Philip B. Paty, Garrett M. Nash, William R. Jarnagin, Mithat Gonen, T. Peter Kingham, and Michael I. D’Angelica have no conflicts of interest to disclose. Jeffrey Drebin reports employment and leadership at American Regent (spouse), and stock and other ownership interests in Alnylam, Arrowhead Pharmaceuticals, and Ions Pharmaceuticals. Alice C. Wei reports consulting fees from Histosonics and institutional research funding from Ipsen. J. Joshua Smith reports travel support for fellow education from Intuitive Surgical (19/20 August 2015), serving as a clinical advisor for Guardant Health (19/20 March 2019) and Foundation Medicine (5 April 2022), serving as a consultant and speaker for Johnson & Johnson (8–10 May 2022), and serving as a clinical advisor and consultant for GlaxoSmithKline (2023). Julio Garcia-Aguilar reports consulting for Ethicon and Intuitive Surgical. Martin R. Weiser reports consulting for PrecisCa and intellectual property rights for UpToDate., (© 2024. Society of Surgical Oncology.)

Competing Interests: Disclosure: Eileen M. O’Reilly reports research funding to Genentech/Roche, BioNTech, AstraZeneca, Arcus, Elicio, Parker Institute, NIH/NCI, Digestive and Care, Break Through Cancer; and consulting/DSMB for Arcus, Alligator, Agenus, BioNTech, Ipsen, Merck, Moma Therapeutics, Novartis, Syros, Leap Therapeutics, Astellas, BMS, Fibrogen, Revolution Medicine, Merus Agios (spouse), Genentech-Roche (spouse), Eisai (spouse), and Servier (spouse). Jeffrey Drebin reports employment and leadership at American Regent (spouse) and stock and other ownership interests in Alnylam, and Arrowhead Pharmaceuticals and Ions pharmaceuticals. Vinod P. Balachandran reports research funding from Genetech/Roche and inventor on patent applications related to antigen cross-reactivity and neoantigen quality modeling. Alice C. Wei reports consulting for Histosonics and clinical trial funding to Ipsen. The remaining authors have no conflicts of interest.