Postoperative Opioid Prescribing Practices and Evidence-Based Guidelines in Bariatric Surgery

Excessive opioid prescribing creates risk for abuse and adverse effects, but must be balanced against individualized pain control. Minimal literature exists to guide providers in the postoperative bariatric surgical setting.

We compare opioid prescribing practice for minimally invasive bariatric surgery in a university hospital with self-reported patient use and satisfaction. This data is used to create practice guidelines for postoperative prescriptions. A 10-question survey was administered at the first postoperative office visit. All patients at this visit were eligible. None declined or excluded. We analyzed 115 patients for 3 procedures: laparoscopic sleeve gastrectomy (LSG; n = 53), laparoscopic roux-en-Y gastric bypass (LRYGB; n = 50), and laparoscopic adjustable gastric band removal (LAGBR; n = 12). Outcomes included number of pills prescribed (verified), proportion used, duration of use, satisfaction with pain control, and non-narcotic analgesic use.

An average of 27 ± 10 pills were dispensed for LSG, average 4.1 days of use; 28 ± 7 pills for LRYGB, 4.6 days; and16 ± 9 pills for LAGBR, 2.6 days. Fifty to 74% retained more than half or all of their opioids at 2 weeks. Fifty-four percent utilized non-narcotic analgesics. Overall, 91.3% reported adequate pain control. For each procedure, average number of pills used was calculated with representative values for "less than half left" (75% of average number of pills prescribed) and "more than half left" (25% of average number of pills prescribed). For LSG, an average of 9 pills were used; LRYGB 14 pills, and LAGBR 7 pills.

Opioids are overprescribed following most common surgical procedures, but only one study has evaluated patterns after bariatric surgery. Our survey-based tool examines prescribing, utilization and satisfaction following common minimally invasive bariatric procedures. Opioid prescriptions were variable, and excessive for most patients. We now recommend prescribing no more than 15 pills after these operations.