Feasibility study on elimination of all oral opioids following bariatric surgery


      • 1.
        Pain is improved when oral opioids are not used after bariatric surgery
      • 2.
        Eliminating oral opioid use after bariatric surgery does not impact length of stay
      • 3.
        Eliminating oral opioid use after bariatric surgery does not impact readmissions rate
      • 4.
        Eliminating the use of oral opioids for post-operative analgesia is safe and feasible



      The bariatric population is at increased risk for developing chronic opioid dependence. The practice of prescribing oral opioids for analgesia in postoperative ambulatory settings is a known risk factor for developing chronic opioid dependence. The use of oral opioids following minimally invasive bariatric surgery may not be necessary.


      To determine whether there is any measurable impact on patient care metrics (length of stay, inpatient delta pain score, 30-day emergency department presentations, and 30-day readmissions) when eliminating the use of oral opioids for postoperative analgesia following laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (SG).


      Retrospective cohort study of data collected at a single bariatric center.


      A cohort of 189 consecutive patients received oral opioids in the immediate postoperative setting, in addition to a prescription for oral opioids at the time of discharge following LRYGB and SG. A second cohort of 136 consecutive patients did not receive oral opioids at any point following surgery. A descriptive bivariate analysis was performed to examine the relationships between cohort characteristics and treatment type. A multivariable linear regression analysis and a logistic regression analysis were conducted to assess the association of treatment type with clinical outcomes of interest.


      The oral opioid–free cohort received significantly fewer morphine milligram equivalents during their postoperative hospital admission (P < .001). There were no differences in lengths of stay, 30-day emergency department presentations, or 30-day readmissions. Patients in the oral opioid–free cohort reported lower average delta pain scores (P < .001).


      Eliminating the use of oral opioids for analgesia following LRYGB and SG does not negatively impact patient care metrics and may improve patient-reported analgesia, as reflected by a significant difference in delta pain scores averages. Elimination of oral opioids from all postoperative analgesia regimens is feasible.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Berterame S.
        • Erthal J.
        • Thomas J.
        • et al.
        Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study.
        Lancet. 2016; 387: 1644-1656
        • Waljee J.F.
        • Li L.
        • Brummett C.M.
        • Englesbe M.J.
        Iatrogenic opioid dependence in the United States.
        Ann Surg. 2017; 265: 728-730
        • Compton W.M.
        • Jones C.M.
        • Baldwin G.T.
        Relationship between nonmedical prescription-opioid use and heroin use.
        N Engl J Med. 2016; 374: 154-163
        • Rudd R.A.
        • Seth P.
        • David F.
        • Scholl L.
        Increases in drug and opioid-involved overdose deaths–United States, 2010–2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452
        • Kaafarani H.M.A.
        Surgeons as part of the solution.
        Ann Surg. 2018; 267: e48
        • Varley P.R.
        • Zuckerbraun B.S.
        Opioid stewardship and the surgeon.
        JAMA Surg. 2018; 153e174875
        • Fujii M.H.
        • Hodges A.C.
        • Russell R.L.
        • et al.
        Post-discharge opioid prescribing and use after common surgical procedure.
        J Am Coll Surg. 2018; 226: 1004-1012
        • Hill M.V.
        • Stucke R.S.
        • Billmeier S.E.
        • Kelly J.L.
        • Barth R.J.
        Guideline for discharge opioid prescriptions after inpatient general surgical procedures.
        J Am Coll Surg. 2018; 226: 996-1003
        • Sekhri S.
        • Arora N.S.
        • Cottrell H.
        • et al.
        Probability of opioid prescription refilling after surgery.
        Ann Surg. 2018; 268: 271-276
        • Yorkgitis B.K.
        • Brat G.A.
        Postoperative opioid prescribing: getting it RIGHTT.
        Am J Surg. 2018; 215: 707-711
        • Levy B.
        • Paulozzi L.
        • Mack K.A.
        • Jones C.M.
        Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012.
        Am J Prev Med. 2015; 49: 409-413
        • Alam A.
        • Gomes T.
        • Zheng H.
        • Mamdani M.M.
        • Juurlink D.N.
        • Bell C.M.
        Long-term analgesic use after low-risk surgery.
        Arch Intern Med. 2012; 172: 425
        • Brummett C.M.
        • Waljee J.F.
        • Goesling J.
        • et al.
        New persistent opioid use after minor and major surgical procedures in US adults.
        JAMA Surg. 2017; 152e170504
        • King W.C.
        • Chen J.Y.
        • Belle S.H.
        • et al.
        Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.
        Surg Obes Relat Dis. 2017; 13: 1337-1346
        • Raebel M.A.
        • Newcomer S.R.
        • Bayliss E.A.
        • et al.
        Chronic opioid use emerging after bariatric surgery.
        Pharmacoepidemiol Drug Saf. 2014; 23: 1247-1257
        • Raebel M.A.
        • Newcomer S.R.
        • Reifler L.M.
        • et al.
        Chronic use of opioid medications before and after bariatric surgery.
        JAMA. 2013; 310: 1369-1376
        • Mechanick J.I.
        • Apovian C.
        • Brethauer S.
        • et al.
        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures–2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery.
        Surg Obes Relat Dis. 2020; 2: 175-247
        • Hariri K.
        • Hechenbleikner E.
        • Dong M.
        • Kini S.U.
        • Fernandez-Ranvier G.
        • Herron D.M.
        Ketorolac use shortens hospital length of stay after bariatric surgery: a single-center 5-year experience.
        Obes Surg. 2019; 29: 2360-2366
        • Hartwig M.
        • Allvin R.
        • Bäckström R.
        • Stenberg E.
        Factors associated with increased experience of postoperative pain after laparoscopic gastric bypass surgery.
        Obes Surg. 2017; 27: 1854-1858
        • Gagliese L.
        • Katz J.
        Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients.
        Pain. 2003; 103: 11-20

      Linked Article

      • Comment on: Feasibility study on elimination of all oral opioids following bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 17Issue 6
        • Preview
          Systemic administration of opioids for short-term postoperative pain has been shown to increase risks for chronic opioid use among a diverse range of patient populations [1]. Bariatric surgery patients may be at particularly high risk for chronic opioid use and misuse postoperatively, as extreme obesity is associated with higher rates of chronic pain, opioid use, and substance misuse [2]. Additionally, anatomic and physiologic changes from some bariatric procedures (e.g., Roux-en-Y gastric bypass [RYGB]) accelerate the rate and extent of opioid absorption, which may increase opioid use motivation [2].
        • Full-Text
        • PDF
      • Comment on: Feasibility study on elimination of all oral opioids following bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 17Issue 6
        • Preview
          With opioid abuse at epidemic proportions, conventional wisdom would support avoidance of narcotic pain medications in the postoperative period. However, we typically do not promote conventional wisdom, and instead seek scientific data to support our recommendations. Meyers et al. [1] have provided us with some well-thought-out scientific data, and for that they should be commended. However, their investigation leaves us with a few unanswered questions:
        • Full-Text
        • PDF