Chenchen Tian, BHSc1, Azusa Maeda, PhD2, Allan Okrainec, MDCM, MHPE, FACS, FRCSC2, Timothy Jackson, MD, MPH, FRCSC, FACS2. 1University of Toronto, Faculty of Medicine, 2University Health Network, Division of General Surgery
Introduction: With rising opioid-related morbidity and mortality, it is critical to understand the implications chronic opioid use on surgical outcomes. Preoperative opioid use before elective abdominal and emergency general surgery has been associated with increased length of stay, costs of care, and readmission rates. Thus, preoperative opioid use represents a potentially modifiable risk factor and a novel target to improve surgical quality of care. The objective of this study was to explore the implications of preoperative opioid use in patients undergoing bariatric surgery on surgical outcomes.
Methods: A single-center retrospective cohort study was performed using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Ontario Bariatric Network (OBN) databases. Patients were selected if they underwent any bariatric procedure between January 1, 2010 and March 31, 2018. Preoperative opioid use, coded as a binary exposure variable, was retrospectively identified from the home medication list in the preoperative evaluation. The primary outcome was the rate of postoperative complications within 30-days of surgery. Secondary outcomes included hospital length of stay, intraoperative complications, and operative time. Continuous variables were compared using Student t-test or Wilcoxon rank-sum test, as appropriate. Categorical variables were compared using chi-squared tests.
Results: Overall, 2479 patients met inclusion criteria. Among those, 291 (11.7%) patients used opioids preoperatively. The majority case mix consisted of Roux-en-Y (88%) and sleeve gastrectomy (11.9%). Opioid users (compared to opioid-naïve) had longer operative time (151m vs 144m, p<.05) and higher rates of intraoperative complications (3.8% vs 2.0%, p<.05).
In a subset of 1266 patients evaluated postoperatively, 123 (9.7%) patients used opioids preoperatively. The majority case mix consisted of Roux-en-Y (85.8%) and sleeve gastrectomy (14.1%). In this cohort, opioid users (compared to opioid-naïve) had higher but not statistically significant rates of postoperative complications (9.0% vs 6.3) and statistically significantly longer hospital length of stay (2.6 vs 2.1 days, p<.001).
Conclusions: Based on MBSAQIP and OBN registry data, opioid users (compared to opioid-naïve) had prolonged operative time, higher rates of intraoperative complications, and prolonged hospital length of stay after bariatric surgery. Preoperative opioid use may complicate perioperative and postoperative management in bariatric procedures. Further investigation is needed to evaluate preoperative opioid use as a potentially modifiable risk factor to improve bariatric quality of care and postoperative outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93895
Program Number: P083
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster