Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery

Abstract

Introduction

New persistent opioid use following surgery is a common iatrogenic complication, developing in roughly 6% of patients after elective surgery. Despite increased awareness of misuse and associated morbidity, opioids remain the cornerstone of pain management in bariatric surgery. The potential impact of new persistent opioid use on long-term postoperative outcomes is unknown. We sought to determine the relationship between new persistent opioid use and 1-year postoperative outcomes for patients undergoing bariatric surgery.

Methods

Using data from the MBSC registry, we identified patients undergoing primary bariatric surgery between 2006 and 2016. Using previously validated patient-reported survey methodology, we evaluated patient opioid use preoperatively and at 1 year following surgery. New persistent use was defined as a previously opioid-naïve patient who self-reported opioid use 1 year after surgery. We used multivariable logistic regression models to evaluate the association between new persistent opioid use, risk-adjusted weight loss, and psychologic outcomes (psychological wellbeing, body image, and depression).

Results

27,799 patients underwent primary bariatric surgery between 2006 and 2016. Among opioid-naïve patients, the rate of new persistent opioid use was 6.3%. At 1-year after surgery, patients with new persistent opioid user lost significantly less excess body weight compared to those without new persistent use (57.6% vs. 60.3%; p < 0.0001). Patients with new persistent opioid use had significantly worse psychological wellbeing (35.0 vs. 33.1; p < 0.0001), body image (19.9 vs. 18.0; p < 0.0001), and depression scores (2.4 vs. 5.0; p < 0.0001). New persistent opioid users also reported less overall satisfaction with their bariatric surgery (75.1% vs. 85.7%; p < 0.0001).

Conclusions

New persistent opioid use is common following bariatric surgery and associated with significantly worse physiologic and psychologic outcomes. More effective screening and postoperative surveillance tools are needed to identify these patients, who likely require more aggressive counseling and treatment to maximize the benefits of bariatric surgery.

Graphical abstract

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Funding

Margaret E. Smith receives funding from the National Institutes of Health Obesity Surgery Scientist Training Grant DK108740-02. Jay S. Lee receives funding from the National Institutes of Health National Research Service Award postdoctoral fellowship CA009672-23. Amir A. Ghaferi receives funding from the Agency for Healthcare Research and Quality (Grants #: 5K08HS02362 and P30HS024403) and a Patient Centered Outcomes Research Institute Award (CE-1304-6596).

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Correspondence to Margaret E. Smith.

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Disclosures

Dr. Oliver Varban and Dr. Jonathan Finks receive salary support from Blue Cross Blue Shield of Michigan as the Associate Directors of the Michigan Bariatric Surgery Collaborative. Dr. Arthur Carlin receives an honorarium from Blue Cross Blue Shield of Michigan as chair of the Executive Committee of the Michigan Bariatric Surgery Collaborative. Dr. Ghaferi receives salary support from Blue Cross Blue Shield of Michigan as the Director of the Michigan Bariatric Surgery Collaborative. Dr. Margaret Smith, Dr. Jay Lee and Aaron Bonham have no conflicts of interest or financial ties to disclose.

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Smith, M.E., Lee, J.S., Bonham, A. et al. Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery. Surg Endosc 33, 2649–2656 (2019). https://doi.org/10.1007/s00464-018-6542-0

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Keywords

  • Bariatric surgery
  • Opioid
  • New persistent opioid use
  • Outcomes
  • Patient reported