Feasibility study on elimination of all oral opioids following bariatric surgery

Background: The bariatric population is at increased risk for developing chronic opioid dependence. The practice of prescribing oral opioids for analgesia in postoperative ambulatory settings is a known risk factor for developing chronic opioid dependence. The use of oral opioids following minimally invasive bariatric surgery may not be necessary.

Objectives: To determine whether there is any measurable impact on patient care metrics (length of stay, inpatient delta pain score, 30-day emergency department presentations, and 30-day readmissions) when eliminating the use of oral opioids for postoperative analgesia following laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (SG).

Setting: Retrospective cohort study of data collected at a single bariatric center.

Methods: A cohort of 189 consecutive patients received oral opioids in the immediate postoperative setting, in addition to a prescription for oral opioids at the time of discharge following LRYGB and SG. A second cohort of 136 consecutive patients did not receive oral opioids at any point following surgery. A descriptive bivariate analysis was performed to examine the relationships between cohort characteristics and treatment type. A multivariable linear regression analysis and a logistic regression analysis were conducted to assess the association of treatment type with clinical outcomes of interest.

Results: The oral opioid-free cohort received significantly fewer morphine milligram equivalents during their postoperative hospital admission (P < .001). There were no differences in lengths of stay, 30-day emergency department presentations, or 30-day readmissions. Patients in the oral opioid-free cohort reported lower average delta pain scores (P < .001).

Conclusion: Eliminating the use of oral opioids for analgesia following LRYGB and SG does not negatively impact patient care metrics and may improve patient-reported analgesia, as reflected by a significant difference in delta pain scores averages. Elimination of oral opioids from all postoperative analgesia regimens is feasible.