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

In this issue of Surgery for Obesity and Related Diseases, Wilson et al. [ ] compared perioperative opioid use among bariatric surgery patients treated within a tertiary care system between those who underwent the standard Enhanced Recovery After Surgery (ERAS) protocol (2017–2019; n = 212 patients) and those who underwent ERAS as well as the Sparing Opioid Use Postoperatively (SOUP) protocol (2019–2021; n = 155 patients). The SOUP protocol was initiated to standardize opioid prescribing practices with a goal of reducing opioid use while providing adequate pain control after bariatric surgery and included preoperative clinic counseling on the protocol. In this retrospective review of prospectively collected data after SOUP initiation, the primary outcome of interest was reduction of opioid use, for which the authors found that SOUP patients required a low to median inpatient morphine equivalent dose (MED) of 4 mg (5 mg oxycodone is equal to 7.5 MED) with a median consumption of 1.5 outpatient 5 mg oxycodone tablets. Of note, no outpatient opioids were prescribed in 7.8% of SOUP patients, only 13.9% were discharged with more than 5 opioid tablets (per provider discretion at the time of discharge), 2.3% consumed more than 5 tablets, and additional new outpatient opioid prescriptions were given in 6.6% of SOUP patients. Secondary outcomes included patient satisfaction with pain control (very high among SOUP patients), index hospitalization length of stay (slightly yet significantly shorter among SOUP patients: average 1.5 mg ± .8 days versus 1.7 6 mg ± .8 days; P < .05), 30-day readmission (low rates, similar between cohorts), and complications (low rates, similar between cohorts). Of note, among ERAS-only patients, 7 patients (3.3%) had an emergency department visit for abdominal pain within 30 days of surgery compared with 4 patients (2.6%) among the SOUP cohort (P = .77). The authors concluded that patients prescribed opioids sparingly after laparoscopic bariatric surgery (SOUP patients) had reduced opioid consumption, high satisfaction with pain control, and similar-to-improved postoperative outcomes.