ASSESSING RISK of NARCOTIC OVERDOSE in PATIENTS UNDERGOING BARIATRIC SURGERY

Document Type

Conference Proceeding

Publication Date

10-27-2021

Publication Title

Surg Endosc

Abstract

Introduction: Obesity-related chronic pain can increase the risk of narcotic abuse in bariatric surgery patients. However, assessment of overdose risk has not been evaluated to date. Methods: A NARxCHECK® overdose score (i.e. "Narx score") was calculated preoperatively on all patients undergoing bariatric surgery (n = 306) between 2018 and 2020 at a single center academic bariatric surgery program. The 3-digit score ranges from low risk (000) to high risk (999) and is based on patient risk factors found within the Prescription Drug Monitoring Program. Patient characteristics, comorbidities, length of stay and emergency room (ER) visits were compared between patients with high (score > 200) and low risk (score = 000) for overdose. Morphine milligram equivalent (MME) prescribed at discharge and refills were also evaluated. Results: Patients with a Narx score > 200 represented 28% (n = 85) of all patients undergoing bariatric surgery and compared to the lowest risk group (n = 101, 33%), were more likely to have depression (60.0% vs 38.6%, p = 0.005), anxiety (45.9% vs 30.7%, p = 0.0351) and bipolar disorder (7.1% vs 0.0%, p = 0.0083). Median MME prescribed at discharge was the same between high and low risk groups (75), however, high risk patients were more likely to be prescribed more than 10 tablets of a secondary opioid (83.3% vs 0%, p = 0.0111), which was prescribed by another provider in 66.7% of the cases. ER visits among patients who did not have a complication or require a readmission was also higher among high risk patients (8.8% vs 0%, p = 0.0083). There were no deaths or incidents of mental health related visits to the ER in either group. Conclusions: Over a quarter of patients undergoing bariatric surgery have an increased risk of narcotic overdose. High risk patients are more likely to have mental health disorders and are also more likely to present to the ER unnecessarily in the setting of standardized opioid prescribing practices. Narx scores can help reduce ER visits by identifying at-risk patients who may benefit from additional clinic or telehealth follow-up.

Volume

35

Issue

1

First Page

S59

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