Factors That Influence Discharge Opioid Prescribing among Bariatric Surgeons across Michigan
Vitous CA, Stricklen AL, Ross RA, Ghaferi AA, Carlin AM, and Ehlers AE. Factors That Influence Discharge Opioid Prescribing among Bariatric Surgeons across Michigan. J Am Coll Surg 2022; 235(5):S2.
J Am Coll Surg
Introduction: Opioid prescribing after bariatric surgery has been an area of focus due to its association with new persistent opioid use (NPOU) and worse outcomes. The development of statewide guidelines has led to a reduction in discharge opioid prescribing, but there remains variation in the number of opioids prescribed by surgeons after bariatric surgery. Understanding the factors underlying this variation may be another way to further improve practices around opioid prescribing.
Methods: We conducted interviews with 20 bariatric surgeons across Michigan to explore factors that influence discharge opioid prescribing after bariatric surgery. All interviewed surgeons participate in a statewide bariatric surgery focused quality improvement collaborative. Transcripts were analyzed using descriptive content analysis.
Results: Surgeons identified factors that influence their decision- making at the patient, provider, institution, and collaborative level. At the patient level, surgeons described the role of surgical history, addiction history, and pain tolerance. At the provider level, surgeons discussed patient dissatisfaction, provider reputation, workload, and involvement with research. At the institution level, surgeons discussed the influence of colleagues, variation in resources, and pressure from administration. At a collaborative level, surgeons described the role of evidence and performance measures. Notably, there was lack of consensus on whether NPOU is a problem facing patients undergoing bariatric surgery.
Conclusion: Despite efforts aimed at addressing opioid prescribing, variability exists in prescribing practices and beliefs among bariatric surgeons across Michigan. Understanding determinants that impact stakeholder alignment and proficiency is critical to the development of tailored intervention aimed at increasing adherence to guideline-concordant care.