Original article|Articles in Press

Evaluating the impact of metabolic surgery on patients with prior opioid use

Published:February 07, 2023DOI:

      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



      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.


      To determine the effect of metabolic surgery on opioid use behaviors in patients with prior opioid use.


      A consortium of public and private hospitals in Michigan.


      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.


      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).


      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


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