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The impact of bariatric surgery on opioid consumption in patients with obesity: a registry-based cohort study

  • Pouya Iranmanesh
    Correspondence
    Contact Information: Pouya Iranmanesh, MD FACS, Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland, Phone number: +41 22 372 13 78.
    Affiliations
    Center for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada

    Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
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  • Karen Barlow
    Affiliations
    Center for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
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  • Mehran Anvari
    Affiliations
    Center for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
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      Highlights

      • The prevalence of opioid usage among patients with obesity is higher than the general population
      • This study shows a significant decrease in the consumption of opioid medication after bariatric surgery
      • Bariatric surgery could be an additional tool to fight the current opioid crisis

      Abstract

      Background

      Misuse of opioid medication has become a major health crisis in several countries. A significant number of patients with obesity use opioid medications, mostly to alleviate symptoms due to obesity-related comorbidities.

      Objectives

      To compare patterns of opioid drugs usage before and after bariatric surgery in this population, hypothesizing that weight loss and improvement of obesity-related comorbidities could reduce opioid consumption.

      Setting

      The Ontario Bariatric Registry (Ontario, Canada).

      Methods

      In this retrospective cohort study, the Ontario Bariatric Registry was used to compare opioid consumption in adult patients undergoing bariatric surgery between 2010 and 2021. The primary outcome was the number of patients using opioid medication at 1-year after surgery. Multiple logistic regression analyses were performed to identify potential predictors of opioid consumption.

      Results

      Data of 11’179 patients were analyzed. Mean age was 45.7±10.2 years, mean baseline BMI was 48.9±8 kg/m2 and 83.6% of patients were female. Roux-en-Y gastric bypass was performed in the majority of patients (85.6%), followed by sleeve gastrectomy (14.2%). At baseline, opioids were used by 7.7% and non-opioid pain medications by 42.3% of patients. At 1-year after surgery, these numbers significantly decreased (Δ-1.9% and Δ-18.0% respectively). The decrease in the consumption of non-opioid pain medication needs to be interpreted in the context of the contraindication to non-steroidal anti-inflammatory drugs after RYGB, which was the most commonly performed procedure. Presence of musculoskeletal pain and use of non-opioid pain medication at baseline were identified as independent predictors of opioid consumption at 1-year after surgery.

      Conclusions

      At 1-year after bariatric surgery, a significant decrease in opioid and non-opioid pain medication consumption was seen among patients with obesity. Aggressive management of excess weight, especially with bariatric surgery, can potentially reduce the impact of the opioid crisis in this population.

      Keywords

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