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Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentations 2 - Facial Plastics and Reconstructive Surgery

Risk Factors of Persistent Opioid Use After Forehead Flap Reconstruction

Monday, October 13, 2025
10:06 AM - 10:12 AM EDT
Location: 137
Disclosure(s):
Alexander J. Barna, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The paramedian forehead flap is a common technique for nasal reconstruction following mohs micrographic surgery for non-melanoma skin cancer. Opioid prescribing patterns after forehead flap reconstructive techniques are heterogenous and differ depending on various defect factors and surgeon preferences. The purpose of this study is to assess the risk of persistent opioid use after forehead flap reconstruction techniques.

Methods: A multicenter cohort study was conducted using the TriNetX, LLC US Collaborative Network was queried for patients who underwent facial reconstruction with a paramedian forehead flap or axial pattern flap. Patients were divided into cohorts based on receiving an opioid prescription within 1 week of surgery. The cohorts were propensity-matched for age, race, ethnicity, sex, psychiatric and pain diagnoses, and previous opioid use. Descriptive statistics were calculated for baseline characteristics using t-tests and chi-square. Risk ratios and chi-squares were calculated to assess associations between variables.

Results: Overall, 6,192 patients were identified and 35.5% of the cohort received a postoperative opioid prescription. The incidence rates of new opioid prescriptions after forehead flap showed an increasing trend from 2003 with 36.5 per 1,000 person years compared to 1,326 per 1,000 person years in 2023. Male patients were more likely to receive a postoperative opioid prescription compared to females (χ2=14.660, p < 0.001). After propensity-score matching, 1,260 patients (630 in each group) were included. Patients who received a postoperative opioid prescription had 2.36 greater risk of developing new persistent opioid use compared to patients not prescribed postoperative opioids (RR = 2.36; 95% CI (1.69,3.30)).

Conclusions: Patients who receive postoperative opioid prescriptions after forehead flap reconstruction are at greater risk of developing new persistent opioid use.

    Presenting Author(s)

  • Alexander J. Barna, MPH

    Medical Student
    Drexel University College of Medicine
    Philadelphia, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Rahul Sharma, MD

    Resident Physician
    Vanderbilt University Medical Ctr
    Nashville, Tennessee, United States

    Disclosure information not submitted.

  • ND

    Nicole G. DeSisto, MD

    Resident Physician
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    Disclosure information not submitted.

  • SS

    Scott J. Stephan, MD

    Associate Professor
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure information not submitted.

  • Priyesh N. Patel, MD

    Assistant Professor; Residency Program Director
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • SY

    Shiayin F. Yang, MD

    Assistant Professor
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    Disclosure information not submitted.