Opioid Requirements After Bariatric Surgery

Abstract

Purpose In light of the current opioid epidemic in the United States, it is important to investigate current opioid prescribing practices and predictors of increased opioid requirement following surgical operations. The objective of this study is to investigate typical opioid requirements and predictors of opioid use after laparoscopic bariatric surgery. Methods This retrospective cohort study was conducted on patients who underwent laparoscopic bariatric surgery between December 2016 and March 2018 at a tertiary care center, specifically laparoscopic Roux-en-Y Gastric Bypass (RYGB), and Laparoscopic Sleeve Gastrectomy (LSG), as well as revisional operations. Postoperative narcotic use was queried prospectively via telephone call on approximately POD7. Both the electronic health record and MBSAQIP data file were used to collect additional patient-centered factors. Multivariate analyses were conducted to predict the number of opioid tablets required and whether patients received a refill. Results 291 patients met our inclusion and exclusion criteria. Mean opioid prescription was 15.2 tablets (95% CI 14.3-16.1). Overall mean number of opioid doses taken after discharge was 4.0 tablets (95% CI 3.4-4.6). The mean opioid requirement after LSG was 3.7 (95% CI 3.1-4.4), after RYGB 4.7 (95% CI 2.8-6.6), and after a revisional operation 5.5 (95% CI 3.7-7.2). Overall, 37.1% of patients reported taking 0 opioid pills after discharge, 50% of patients required ≤2 pills, 75% required ≤6, and 4.5% reported having taken all of the opioid pills prescribed. In multivariate analysis, increased opioid requirement was associated with younger age (p<.001), increased operative time (p<0.001), chronic opioid use (p=0.041), and number of opioid tablets prescribed (p<.001). Controlling for other factors, patients undergoing RYGB had a slightly lower opioid requirement relative to other operations (p=.032) as well as patients undergoing surgery in 2018 (vs. 2017) (p=0.003). The only significant predictor of opioid refills was chronic opioid use. Conclusions This study found that most patients use far fewer opioid tablets than prescribed after bariatric surgery, suggesting there is room to decrease the quantity prescribed.