Bariatric surgery targeting opioid prescribing: a national model for effectively reducing opioid use after bariatric surgery

Background: Prescription opioids are responsible for a significant proportion of opioid-related deaths in the United States. Approximately 6% of opioid-naïve patients who receive opioid prescriptions after surgery become chronic opioid users. However, chronic opioid use after bariatric surgery may be twice as common.

Objectives: This study aimed to report the feasibility and efficacy of implementing a national opioid-reducing protocol and to determine the impact of this protocol on opioid use after bariatric surgery.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited hospitals.

Methods: Bariatric surgery targeting opioid prescription (BSTOP) was a national project sponsored by the MBSAQIP. It was executed in 3 phases: baseline, pilot, and implementation. A total of 271 MBSAQIP-accredited centers implemented the BSTOP protocol and reported data for all 3 phases. Protocol adherence, inpatient opioid use, opioids discharge prescribing, and outpatient opioid use were analyzed. Hospital-level opioid prescription habits were also assessed.

Results: Compliance with 6 of 9 process measures improved significantly (P < .001). Median morphine milligram equivalents (MMEs) prescribed during inpatient stay decreased from 35 MMEs during data collection to 23 MMEs during the implementation phase (Dwass-Steel-Critchlow-Fligner, P < .001). Opioids prescribed at discharge decreased by 9.5% (P < .001). Low inpatient MME prescriptions were achieved by 14.2% of hospitals, while 15.7% of hospitals became low-discharge opioid prescribers.

Conclusions: Implementation of a national opioid-reducing protocol in bariatric surgery is feasible and effective in reducing opioid prescribing and use. However, the adoption of postdischarge prescription guidelines remains low. Opportunities to reduce the impact of prescription opioids on overdose deaths persist.