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How much narcotics are really needed after bariatric surgery: results of a prospective study

Published:November 18, 2022DOI:https://doi.org/10.1016/j.soard.2022.11.011

      Highlights

      • Opioids can be reduced drastically after primary bariatric surgery.
      • Patients remain with high pain satisfaction despite decreased narcotics.
      • Readmission rates are unchanged with decreased narcotic usage.

      Abstract

      Background

      To mitigate the opioid crisis, physicians are reevaluating opioid prescribing patterns.

      Objectives

      To evaluate outcomes of maximal opioid reduction on top of an existing Enhanced Recovery after Surgery (ERAS) pathway in our The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited bariatric surgery program.

      Setting

      Academic tertiary care hospital, United States.

      Methods

      Patients undergoing primary bariatric operation were studied from July 2017 to April 2019, (standard ERAS cohort), and compared to patients from April 2019 to February 2021 (standard ERAS with Sparing Opioid Use Postoperatively protocol) (SOUP cohort). The primary endpoint was reduction of perioperative opioid use.

      Results

      Of 367 patients, 212 (57.8%) and 155 (42.2%) were in the ERAS and SOUP cohorts, respectively. Roux-en-Y gastric bypass was 48.6% (n = 103) versus 54.2% (n = 84) and sleeve gastrectomy was 51.4% (n = 109) versus 45.8% (n = 71) for ERAS versus SOUP, respectively (P = .29).
      The SOUP cohort of patients required a low median inpatient morphine equivalent dose of 4 mg [0–6.2]. The ERAS cohort was discharged on a higher morphine equivalent dose than the SOUP cohort at 186.7 mg ± 92.9 versus 37.6 ± 32.3 (P < .05), and median consumption of the standard 5 mg oxycodone tablet was 1.5 tablets [0–4]. The SOUP cohort patients rated their pain satisfaction score on a scale of 1 to 10 at 9.1 points (standard deviation ± 1.8). The SOUP cohort had a shorter length of stay (P < .05), with comparable readmission rates.

      Conclusions

      An opioid-sparing protocol can be implemented after bariatric surgery with high overall satisfaction with pain control.

      Keywords

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