Opioid Requirements After Bariatric Surgery
*Deanna Palenzuela1, *Karan Chhabra2, *Robert Matthews2, *Jason Pradarelli2, Ali Tavakkoli2
1Harvard Medical School, Boston, MA; 2Brigham and Women's Hospital, Boston, MA
Objective. To investigate typical opioid requirements and predictors of opioid use after laparoscopic bariatric surgery.
Design. Retrospective cohort study. Postoperative narcotic use was queried prospectively via telephone call on approximately POD7. Additional information including postoperative complications, amount of opioid prescribed, and comorbidities were queried via retrospective review. Both the electronic health record and MBSQIP data file were used. Univariate analyses were performed in SPSS.
Setting. Academic tertiary care hospital and affiliated community hospitals.
Patients. All patients who underwent laparoscopic bariatric surgery between December 2016 - March 2018 (N=323), specifically Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and “revisional operations”: sleeve revision to RYGB, gastric band revision/removal and RYGB revision.
Main Outcome Measure. Opioid requirement after discharge from bariatric surgery based on patient reported number of opioid doses (oxycodone 5 mg or hydromorphone 2 mg) taken by POD7.
Results. In the unadjusted analysis, mean opioid prescription was 14.9 doses (95% CI 14.1, 15.7). Overall mean number of opioid doses taken after discharge was 3.84 (3.3, 4.4). The mean opioid requirement after sleeve gastrectomy was 3.55 (3.76, 7.18), after RYGB was 4.7 (2.83, 6.56), and after a revisional operation was 5.4 (2.96, 4.15). The difference between sleeve and revision was statistically significant (p=.038) There was no significant correlation between the number of opioids prescribed and taken (R2=0.014). Overall, 39% of patients reported taking 0 opioid pills after discharge, 50% of patients required ≤2 pills, 75% required ≤6, and 4.6% reported having taken all of the opioid pills prescribed.
Conclusions. Most patients use far fewer opioid tablets than prescribed after bariatric surgery, suggesting there is room to decrease the quantity prescribed.