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Long-term opioid use after bariatric surgery.

Matthew L Maciejewski1, Valerie A Smith1, Theodore S Z Berkowitz2

  • 1Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.

Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery
|June 9, 2020
PubMed
Summary

Bariatric surgery increases the risk of chronic prescription opioid use (CPOU) in opioid-naïve patients, but does not affect CPOU persistence in those with prior use. This study analyzed veteran data to compare surgical and nonsurgical outcomes.

Keywords:
BariatricGastric bypassMatchingMedicationObesityOpioidSleeve gastrectomySurgeryVeterans

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Area of Science:

  • Bariatric surgery outcomes
  • Opioid use and addiction research
  • Health services research in veterans

Background:

  • Opioid analgesics are frequently prescribed post-bariatric surgery.
  • Risk of developing chronic prescription opioid use (CPOU) exists, even in opioid-naïve individuals.
  • Bariatric surgery's impact on CPOU varies based on presurgical opioid use status.

Purpose of the Study:

  • To compare CPOU persistence and incidence after bariatric surgery versus matched controls.
  • Investigate differences in CPOU based on bariatric surgery type (open RYGB, laparoscopic RYGB, LSG).
  • Analyze CPOU trends in a large cohort of veterans undergoing bariatric procedures.

Main Methods:

  • Retrospective cohort study design utilizing Veterans Affairs hospitals.
  • Matched 1117 surgical patients with baseline CPOU to 9531 controls; 2822 surgical patients without CPOU to 26,392 controls.
  • Generalized estimating equations and Cox regression models used to estimate CPOU persistence and incidence by procedure type.

Main Results:

  • Postsurgical CPOU declined in patients with baseline CPOU, with no difference between surgical and nonsurgical groups.
  • Bariatric surgery patients without baseline CPOU showed higher CPOU incidence within 5 years post-surgery compared to controls.
  • Specific procedures like open RYGB, laparoscopic RYGB, and LSG were associated with increased CPOU incidence.

Conclusions:

  • Bariatric surgery is linked to a higher incidence of CPOU in patients without prior opioid use.
  • Bariatric surgery did not demonstrate an association with increased CPOU persistence.
  • Findings highlight the importance of monitoring opioid use post-bariatric procedures, especially in opioid-naïve individuals.