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Variation in opioid-free discharge after metabolic surgery from 2018 to 2023: a state-wide analysis from the Michigan
Mae Crumbley1, Sarah Petersen2, Aaron J Bonham2
1University of Michigan Medical School, Ann Arbor, Michigan.
Background:
Efforts have been made to reduce opioid prescribing after metabolic-bariatric surgery (MBS) given the increased risk for misuse. Variation in prevalence of opioid-free discharge following MBS and its impact on outcomes remains unclear.
Objectives:
To evaluate variation in opioid prescribing practices after MBS and the impact of opioid-free discharge on outcomes.
Setting:
MBS programs participating in a state-wide quality improvement collaborative.
Methods:
Using a state-wide bariatric-specific data registry, all patients who underwent MBS between 2018 and 2023 and had opioid prescribing data were identified (n = 54,276). Patient characteristics and 30-day risk-adjusted outcomes were compared between patients who were and were not prescribed opioids at discharge. Surgeon and practice characteristics were also compared between the top and bottom quartiles of opioid-free discharge.
Results:
The prevalence of opioid-free discharge increased from 7.7% to 32.1% over the study period. Only .4% of patients, who were opioid-free at discharge, obtained an opioid prescription within 30 days of discharge. Opioid-free discharge was associated with lower rates of emergency department (ED) visits (7.7% vs 8.2%, P = .0008), despite similar complication rates (7.6% vs 7.3%, P = .7261). There were no significant differences in age, case volume, or practice types between surgeons in the top quartile and bottom quartile for opioid-free discharge.
Conclusions:
Opioid-free discharge after MBS has increased in prevalence with extremely low failure rates without negatively impacting ED visit rates. Variation in opioid prescribing persists and may be due to patient-specific factors as well as surgeon-specific preference.
Insights
Opioid-free discharge after metabolic-bariatric surgery (MBS) is increasing, with low failure rates and no negative impact on emergency department visits. Prescribing variations persist, influenced by patient and surgeon factors.
Area of Science:
- Bariatric Surgery
- Pain Management
- Opioid Prescribing Practices
Background:
- Metabolic-bariatric surgery (MBS) carries an increased risk for opioid misuse.
- Variation in opioid-free discharge rates and outcomes post-MBS is not well understood.
Purpose of the Study:
- To assess the variability in opioid prescribing after MBS.
- To determine the impact of opioid-free discharge on patient outcomes.
Main Methods:
- Utilized a state-wide bariatric-specific data registry for 54,276 MBS patients (2018-2023).
- Compared 30-day outcomes between patients with and without opioid discharge prescriptions.
- Analyzed surgeon and practice characteristics related to opioid-free discharge rates.
Main Results:
- Opioid-free discharge prevalence rose from 7.7% to 32.1% during the study.
- Opioid-free discharge was linked to lower emergency department (ED) visit rates (7.7% vs. 8.2%).
- Complication rates were similar between groups; no significant differences in surgeon/practice factors were found.
Conclusions:
- Opioid-free discharge post-MBS is feasible and safe, with minimal 30-day opioid prescription failure.
- Increased opioid-free discharge rates did not negatively affect ED visit rates.
- Persistent variation in prescribing suggests influence from patient-specific and surgeon-specific factors.
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