Margaret E Smith, MD, Aaron Bonham, MSc, Amir Ghaferi, MD, MS. University of Michigan
INTRODUCTION: New persistent opioid use occurs in roughly 6% of patients following elective surgery. Given concerns for addiction transfer, bariatric patients may be at increased risk of developing persistent opioid use postoperatively. Previous work demonstrated as many as 8.8% of bariatric opioid naïve patients reported new persistent opioid use 1 year following surgery. Beyond the direct adverse effects of long-term opioid use, the impact of persistent use on bariatric surgery outcomes is unclear. We sought to determine the relationship between new persistent opioid use and short and long-term outcomes following bariatric surgery.
METHODS AND PROCEDURES: Using data from a large statewide quality collaborative, we identified patients undergoing primary, non-revisional bariatric surgery between 2006-2016 who had baseline and 1 year follow-up data (n=25,103). Using previously validated patient-reported survey methodology, we ascertained opioid use at baseline preoperatively and at 1 year following surgery. New persistent use was defined as patients with no reported preoperative opioid use who subsequently report use at 1 year. Risk and reliability-adjusted short- and long-term outcomes were assessed in patients with new persistent opioid use compared to those without using a hierarchical logistic regression model accounting for patient demographics.
RESULTS: In our cohort of 25,103 patients, 78.5% (n=19,706) of patients denied opioid use preoperatively. 8.0% (n=1,577) of these opioid naïve patients reported new persistent opioid use one year after surgery. After accounting for all baseline demographic and co-morbidity differences, patients with new persistent opioid use were more likely to have suffered a post-operative complication compared with opioid naïve patients with no long-term use (9.4% v 6.1%, p <0.001). New persistent users also had significantly less weight loss at one year following surgery, based on percent of excessive body weight lost (57.6% v 60.3%, p<0.001).
CONCLUSION(S): New persistent opioid use following bariatric surgery develops at higher rates than in other general surgery patients and is associated with overall poorer weight loss after one year. Given concerns for an increased risk of addiction transfer and worse long-term outcomes in new persistent opioid use patients, increased awareness and support should be directed toward identifying patients with prolonged or excessive opioid use in the post-operative period. These efforts may be especially beneficial for patients with post-operative complications, who are at higher risk of developing persistent opioid use habits.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87993
Program Number: S136
Presentation Session: Plenary 2 Session
Presentation Type: Podium