Highlights - Evaluating the Impact of Metabolic Surgery on Patients with Prior Opioid Use
- •45% of patients with opioid use prior to surgery discontinued use at 1 year
- •Income <$10K and preoperative tobacco use were associated with opioid persistence
- •Persistent opioid use was not associated with MMEs prescribed after surgery
- •Persistent opioid use was associated with lower percent excess body weight loss
Abstract
Background
Metabolic surgery is the most effective treatment for obesity and may improve obesity-related
pain syndromes. However, the effect of surgery on the persistent use of opioids in
patients with a history of prior opioid use remains unclear.
Objective
To determine the effect of metabolic surgery on opioid use behaviors in patients with
prior opioid use.
Setting
A consortium of public and private hospitals in Michigan.
Methods
Using a statewide metabolic-specific data registry, we identified 16,820 patients
who self-reported opioid use before undergoing metabolic surgery between 2006 and
2020 and analyzed the 8506 (50.6%) patients who responded to 1-year follow-up. We
compared patient characteristics, risk-adjusted 30-day postoperative outcomes, and
weight loss between patients who self-reported discontinuing opioid use 1 year after
surgery and those who did not.
Results
Among patients who self-reported using opioids before metabolic surgery, 3864 (45.4%)
discontinued use 1 year after surgery. Predictors of persistent opioid use included
an annual income of <$10,000 (odds ratio [OR] = 1.24; 95% confidence interval [CI],
1.06–1.44; P = .006), Medicare insurance (OR = 1.48; 95% CI, 1.32–1.66; P < .0001), and preoperative tobacco use (OR = 1.36; 95% CI, 1.16–1.59; P = .0001). Patients with persistent use were more likely to have a surgical complication
(9.6% versus 7.5%, P = .0328) and less percent excess weight loss (61.6% versus 64.4%, P < .0001) than patients who discontinued opioids after surgery. There were no differences
in the morphine milligram equivalents prescribed within the first 30 days following
surgery between groups (122.3 versus 126.5, P = .3181).
Conclusions
Nearly half of patients who reported taking opioids before metabolic surgery discontinued
use at 1 year. Targeted interventions aimed at high-risk patients may increase the
number of patients who discontinue opioid use after metabolic surgery.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 07, 2023
Accepted:
January 29,
2023
Received:
October 22,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This work was supported by Blue Cross Blue Shield of Michigan/Blue Care Network. The funding source was not involved in the collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication.
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
