Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

Abstract

Background Limited evidence suggests bariatric surgery may not reduce opioid analgesic use, despite improvements in pain. Objective To determine if use of prescribed opioid analgesics changes in the short- and long-term following bariatric surgery and to identify factors associated with continued and post-surgery initiated use. Setting Ten US hospitals. Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Assessments were conducted pre-surgery, 6 months post-surgery and annually post-surgery for up to 7 years until January 2015. Opioid use was defined as self-reported daily, weekly or “as needed” use of a prescribed medication classified as an opioid analgesic. Results Of 2258 participants with baseline data, 2218 completed follow-up assessment(s) (78.7% were female, median body mass index 46; 70.6% underwent Roux-en-Y gastric bypass). Prevalence of opioid use decreased following surgery from 14.7% (95% CI, 13.3–16.2) at baseline to 12.9% (95% CI, 11.5–14.4) at month-6, but then increased to higher than baseline levels as time progressed to 20.3% (95% CI, 18.2–22.5) at year-7. Among participants without baseline opioid use (N=1892), opioid use prevalence increased from 5.8% (95% CI, 4.7–6.9) at month-6 to 14.2% (95%CI, 12.2–16.3) at year-7. Public versus private health insurance, more pain pre-surgery, undergoing subsequent surgeries, worsening/less improvement in pain, and starting or continuing non-opioid analgesics post-surgery were significantly associated with higher risk of post-surgery initiated opioid use. Conclusion Following bariatric surgery, prevalence of prescribed opioid analgesic use initially decreased, but then increased, surpassing baseline prevalence, suggesting the need for alternative methods of pain management in this population.

Use of Opioid Analgesics Before and After Gastric Bypass Surgery in Sweden: a Population-Based Study

“…Previous studies have shown an unexpected increase in opioid analgesics consumption after bariatric surgery [6][7][8][9]. Our results with a larger population are consistent with their findings.…”

“…2 approximately 25% of these patients significantly decrease their consumption and the remainder increase it. Mean age among HOCs was significantly lower after surgery ( Table 2); this potentially protective effect has been shown previously [8] but not repeatedly [7], and there are many potentially confounding factors that we in this study are unable to adjust for. The number of HOC individuals in the total population appeared to increase fairly consistently, and if the 3-month period after surgery is excluded, bariatric surgery does not seem to have had an impact on this increase (Fig.…”

“…Little is known regarding the use of opioid analgesics among patients who have undergone bariatric surgery. Recent studies has shown an increase in postoperative use of opioid analgesics both regarding the total dose and number of new persistent users [6][7][8][9]. The anatomical changes after Roux-en-Y gastric bypass (RYGB) can lead to changes in the pharmacokinetic properties of opioid analgesics leading to faster and more complete absorption of morphine oral solution [10], which is similar to the changes seen with ethanol [11].…”

Weight loss and effect on co-morbidities in the long-term after duodenal switch and gastric bypass: a population-based cohort study

“…This is surprisingly because the massive weight loss, especially in DS, should reduce the patients' musculoskeletal pain. In recent years, there has been a concern about opioid analgesic use among bariatric patients, with 2 studies, 1 from the United States [21] and 1 from Sweden [22], reporting an overall increased use of opioids after bariatric surgery. It is possible that the effect on weight-related pain is overshadowed by the surgical trauma (bariatric operation and subsequent additional procedures) in combination with high prevalence at baseline, 2 important factors predisposing for chronic opioid use [23,24].…”

Proceedings of the 2017 ASPEN Research Workshop—Gastric Bypass: Role of the Gut

“…The risk for malnutrition after RYGB reduces its safety profile. Adverse outcomes related to function and quality of life 139,140 would be reduced if nutrition support of these patients was improved. Therefore, patients, practitioners, and other stakeholders need to know the best practices for the treatment and prevention of nutrition deficiencies.…”