Highlights
- •12.7% of patients who underwent bariatric surgery tested positive on toxicology screening.
- •There was no association between a positive toxicology screening and outcomes of preoperative length, 30-day complications, 30-day readmissions, and 1-year weight loss.
- •This calls into question the utility of routine preoperative toxicology screening.
Abstract
Background
Some programs and insurers may require patients to undergo toxicology screening despite
lack of evidence that this practice affects postoperative outcomes.
Objectives
To understand the prevalence of screening positive on toxicology testing in the bariatric
surgical population and to examine the association between testing positive and important
surgical outcomes.
Methods
We performed a retrospective review of patients who underwent laparoscopic sleeve
gastrectomy or Roux-en-Y gastric bypass from an academic health system from 2017–2020.
We described the rate of preoperative toxicology positivity as determined by serum
and urine testing. We examined the association between toxicology positivity and outcomes
of preoperative length, 30-day complications (bleeding, venous thromboembolism, leak,
wound infection, pneumonia, urinary tract infection, and myocardial infarction), readmissions,
and 1-year weight loss using chi-square and t-test analysis.
Results
Of 1057 patients, there were 134 patients (12.7%) who had positive toxicology testing.
Of these, 37 (28%) were positive for opiates and 21 (16%) were positive for cotinine.
Mean preoperative length was 381.8 days (standard deviation [SD], 222.5) for patients
with positive testing versus 287.8 days (SD, 151.5; P = 1.00) for negative testing. Toxicology positivity was not associated with readmissions
(5.2% versus 4.3%, X2 = 0.22; P = .64). The loss to follow-up at 1 year was 32.5%. There was no association with
1-year mean change in body mass index (mean of loss 12.23kg/m2 [SD, 5.61]) versus mean of loss 12.74 (SD, 6.44; P = .20)].
Conclusions
Our study is the first to describe preoperative toxicology positivity rates. We found
no association between toxicology positivity and preoperative length, readmissions,
or weight loss. Given its lack of impact on outcomes, toxicology testing prior to
bariatric surgery may be an unnecessary burden on patients and healthcare, with regard
to cost and wait times.
Graphical abstract
Graphical Abstract
Keywords
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 accessOne-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:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- National healthcare expenditures, 2019: steady spending growth despite increase in personal health care expenditures in advance of the pandemic.in: American Medical Association Policy Research Perspectives. 2020 (chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ama-assn.org/system/files/2021-05/prp-annual-spending-2019.pdf, Accessed November 17, 2022)
- Choosing Wisely - Our Mission.2021 (www.choosingwisely.org. Accessed November 17, 2022)
- Unindicated preoperative testing: ASA physical status and financial implications.J Clin Anesth. 1997; 9: 437-441
- Cost-effective preoperative evaluation and testing.Chest. 1999; 115: 96S-100S
- Ambulatory surgery: how much testing do we need?.Anesthesiol Clin. 2010; 28: 185-197
- Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service medicare beneficiaries.JAMA Intern Med. 2019; 179: 1211-1219
- Cascades of care after incidental findings in a US national survey of physicians.JAMA Netw Open. 2019; 2: e1913325
- Use of preoperative laboratory testing among low-risk patients undergoing elective anorectal surgery.J Surg Res. 2022; 270: 421-429
- Patterns and determinants of low-value preoperative testing in Michigan.JAMA Intern Med. 2021; 181: 1115-1118
- The usefulness of preoperative laboratory screening.JAMA. 1985; 253: 3576-3581
- Factors associated with bariatric surgery utilization among eligible candidates: who drops out?.Surg Obes Relat Dis. 2018; 14: 1903-1910
- Analysis of patient attrition in a publicly funded bariatric surgery program.J Am Coll Surg. 2014; 219: 1047-1055
- Changes in utilization of bariatric surgery in the United States from 1993 to 2016.Ann Surg. 2020; 271: 201-209
- High-risk alcohol use and disordered eating behavior before and 1 Year after sleeve gastrectomy.Obes Surg. 2022; 32: 593-598
- Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.Surg Obes Relat Dis. 2017; 13: 1392-1402
- Association of bariatric surgical procedures with changes in unhealthy alcohol use among US veterans.JAMA Netw Open. 2020; 3: e2028117
- Bariatric surgery and alcohol and substance abuse disorder: a systematic review.Cir Esp (Engl Ed). 2021; 99: 635-647
- Exploring pre-surgery and post-surgery substance use disorder and alcohol use disorder in bariatric surgery: a qualitative scoping review.Int J Obes (Lond). 2019; 43: 1659-1674
- Marijuana use does not affect weight loss or complication rate after bariatric surgery.Surg Endosc. 2022; 36: 6931-6936
- Marijuana use does not affect the outcomes of bariatric surgery.Surg Endosc. 2021; 35: 1264-1268
- Impact of smoking on weight loss outcomes after bariatric surgery: a literature review.Surg Endosc. 2021; 35: 5936-5952
- Tobacco use and substance use disorders as predictors of postoperative weight loss 2 years after bariatric surgery.J Behav Health Serv Res. 2012; 39: 462-471
- Predictors of initial weight loss after gastric bypass surgery in twelve veterans affairs medical centers.Obes Res Clin Pract. 2013; 7: e367-e376
- Smoking and alcohol use in gastric bypass patients.Eat Behav. 2013; 14: 460-463
- Effect of patient-reported smoking status on short-term bariatric surgery outcomes.Surg Endosc. 2018; 32: 720-726
- Effects of smoking on bariatric surgery postoperative weight loss and patient satisfaction.Surg Endosc. 2021; 35: 3584-3591
- Intersection of smoking, e-cigarette use, obesity, and metabolic and bariatric surgery: a systematic review of the current state of evidence.J Addict Dis. 2021; 39: 331-346
- Obesity and mental disorders in the general population: results from the world mental health surveys.Int J Obes (Lond). 2008; 32: 192-200
- Obesity and anxiety symptoms: a systematic review and meta-analysis.Neuropsychiatr. 2019; 33: 72-89
- Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery.Int J Obes (Lond). 2007; 31: 114-120
- Chronic use of opioid medications before and after bariatric surgery.JAMA. 2013; 310: 1369-1376
- 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
- Patient characteristics and outcomes among bariatric surgery patients with high narcotic overdose scores.Surg Endosc. 2022; 36: 9313-9320
- Opioids and bariatric surgery: a review and suggested recommendations for assessment and risk reduction.Surg Obes Relat Dis. 2019; 15: 314-321
- Association of bariatric surgery and national medication use.J Am Coll Surg. 2019; 228: 171-179
Article info
Publication history
Published online: October 31, 2022
Accepted:
October 9,
2022
Received:
June 21,
2022
Footnotes
Oral Presentation: June 9, 2022 at the ASMBS National Conference in Dallas, TX.
Manuscript for consideration for The Halverson Award.
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: The role of preoperative toxicology screening in patients undergoing bariatric surgerySurgery for Obesity and Related DiseasesVol. 19Issue 3
