Hospital opioid use predicts the need for discharge opioid prescriptions following laparoscopic bariatric surgery

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Surgical endoscopy


BACKGROUND: Overprescribing of opioids after surgery increases new persistent opioid use and diversion contributing to the opioid epidemic. There is a paucity of evidence regarding discharge opioid prescribing after bariatric surgery.

METHODS: We conducted a retrospective, cohort study analyzing post-operative opioid use at a single institution in patients who underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LGB) from July 2019 thru February 2020. Multimodal analgesia was used including 5 mg oxycodone pills as needed during hospitalization with five prescribed on discharge if requested after discussion. Opioid use was determined from medical record review and post-operative data collected from patients at a 2-week follow-up visit. The Michigan Automated Prescription System (MAPS) was used as an adjunct to evaluate perioperative opioid prescriptions.

RESULTS: The cohort of 84 patients included those having LSG (72) and LGB (12). Fifty-five patients (65%) received a prescription for opioids on discharge and 91% filled their prescription. Only 44% (22/50) of those filling their opioid prescription took any opioids with 24% (65/275) of the total pills prescribed actually consumed. Opioid use on the surgical ward had the strongest correlation with discharge opioid use (rho = 0.65, CI 0.494, 0.770). The number of opioid pills taken on the surgical ward was positively associated with the number of pills taken after discharge. Those who took none, 1 to 3, or 4 or more opioid pills consumed 0.14 ± 0.48, 0.95 ± 1.71, and 3.14 ± 1.86 pills after discharge (p < 0.001). No patients required an additional opioid prescription within 90 days of surgery with MAPS confirmation.

CONCLUSION: Postoperative in-hospital opioid use following laparoscopic bariatric surgery predicts opioid use after discharge. This knowledge can guide patient-specific discharge opioid prescribing with the potential to mitigate diversion and reduce chronic opioid use.

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ePub ahead of print