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New persistent opioid use after bariatric surgery: a systematic review and pooled proportion meta-analysis

  • 2022 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Increasing evidence suggests surgical patients are at risk for developing new, persistent opioid use (NPOU) following surgery. This risk may be heightened for patients undergoing bariatric surgery. Few studies have evaluated this important long-term outcome and little is known about the rate of NPOU, or factors associated with NPOU for bariatric surgery patients.

Methods and procedure

We conducted a systematic review of MEDLINE, Embase, Scopus, Web of Science, and Cochrane databases in August 2021. Studies were reviewed and data extracted independently by two reviewers following MOOSE guidelines. Studies evaluating bariatric surgery patients reporting NPOU, defined as new opioid use > 90 days after surgery, were included. Abstracts, non-English, animal, n < 5, and pediatric studies were excluded. Primary outcome was NPOU prevalence, and secondary outcomes were patient and surgical factors associated with NPOU. Factors associated with NPOU are reported from findings of individual studies; meta-analysis could not be completed due to heterogeneity of reporting.

Results

We retrieved a total of 2113 studies with 8 meeting inclusion criteria. In studies reporting NPOU rates (n = 4 studies), pooled prevalence was 6.0% (95% CI 4.0–7.0%). Patient characteristics reported by studies to be associated with NPOU included prior substance use (tobacco, alcohol, other prescription analgesics), preoperative mental health disorder (anxiety, mood disorders, eating disorders), and public health insurance. Surgical factors associated with NPOU included severe post-operative complications and in-hospital opioid use (peri- or post operatively).

Conclusions

NPOU is an uncommon but important complication following bariatric surgery, with patient factors including prior substance abuse, mental health disorders, and use of public health insurance placing patients at increased risk, and surgical factors being complications and peri-operative opioid use. Studies evaluating techniques to reduce NPOU in these high-risk populations are needed.

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Funding

There is no funding or grant support for this study.

Author information

Authors and Affiliations

  1. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Khadija Nasser

  2. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Kevin Verhoeff, Valentin Mocanu, Kieran Purich & Noah J. Switzer

  3. John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada

    Janice Y. Kung

  4. Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada

    Daniel W. Birch & Shahzeer Karmali

  5. Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom, 2G2 Walter C. Mackenzie Health Sciences Centre, 8440, 112 St NW, Edmonton, AB, T6G 2B7, Canada

    Kevin Verhoeff

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  1. Khadija Nasser
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Corresponding author

Correspondence to Kevin Verhoeff.

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Disclosures

Khadija Nasser, Kevin Verhoeff, Valentin Mocanu, Janice Y. Kung, Kieran Purich, Noah J. Switzer, Daniel W. Birch, and Shahzeer Karmali have no conflicts of interest or financial ties to disclose.

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Supplementary Information

Appendix

Appendix

Search strategies

Database

Search strategy

MEDLINE

Ovid MEDLINE(R) ALL 1946 to August 19, 2021

1. bariatric*.mp. or exp Bariatric Surgery/

2. exp Biliopancreatic Diversion/ or (biliopancreatic diversion* or biliopancreatic bypass).mp

3. duodenal switch*.mp

4. (gastric bypass* or gastric surger*).mp

5. exp Gastroenterostomy/ or gastroenterostom*.mp

6. gastrogastrostom*.mp

7. gastrojejunostom*.mp

8. gastroileal bypass.mp

9. gastroplast*.mp

10. intestin* bypass.mp. or exp Jejunoileal Bypass/

11. ((jejunoileal or jejuno-ileal or jejunoilial or jejuno-ilial or jejunocolic) adj bypass).mp

12. mason* procedure*.mp

13. ((obesity or obese or weight) adj5 surg*).mp

14. exp Obesity/su [Surgery]

15. restrictive surger*.mp

16. roux-en-y.mp. or exp Anastomosis, Roux-en-Y/

17. scopinaro.mp

18. sleeve gastrectom*.mp

19. ((stomach or gastric) adj5 stapl*).mp

20. (SADI or SADI-S or single anastomosis duodeno*).mp

21. or/1-20

22. (Abstral or Actiq or Alfentanil or Anexsia or Astramorph or Avinza or buprenorphine or Butrans or carfentan* or Codeine or Co-Gesic or Demerol or dextropropoxyphene or Diamorphine or Dilaudid or Dolophine or Duragesic or Embeda or Endocet or Exalgo or Fentanyl or Fentora or heroin or Hycet or Hycodan or Hydrocodone or Hydromet or hydromorphone or Hysingla or Ibudone or Kadian or levorphanol or levopropoxyphene or Liquicet or Lorcet or Lortab or Maxidone or meperidine or Morphabond or morphine or MS Contin or Nalbuphine or narcotic* or Norco or Nubain or Nucynta ER or Opana ER or opiate* or opioid* or opium or Onsolis or Oramorph or Ora-Morph or Oxaydo or Oxecta or Oxycet or oxycodone or OxyContin or Oxymorphone hydrochloride or Palladone or Pentazocine or Percocet or Percodan or Pethidine or Reprexain or Rezira or Roxanol* or Roxicet or Roxicodone or Roxycodone or Sublimaze or Sufentanil or tapentadol or Targiniq ER or tramacet or tramadol or TussiCaps or Tussionex or Tuzistra XR or Vicodin or Vicoprofen or Vituz or Xartemis XR or Xodol or Xtampza ER or Zohydro ER or Zolvit or Zutripro or Zydone).mp

23. exp Opioid-Related Disorders/

24. exp Analgesics, Opioid/

25. or/22-24

26. (post-operative* or postoperative* or post-surg* or postsurg*).mp

27. ((post or after or follow*) adj3 (operat* or surg* or procedur* or gastrectom* or roux-en-y or bypass or gastric or sleeve)).mp

28. Pain, Postoperative/

29. Postoperative Complications/

30. or/26-29

31. 21 and 25 and 30

32. animals/

33. humans/

34. 32 not (32 and 33)

35. (veterinary or rabbit or rabbits or animal or animals or mouse or mice or rodent or rodents or rat or rats or murine or hamster* or pig or pigs or piglets or swine or porcine or horse* or equine or cow or cows or cattle or bovine or goat or goats or sheep or lambs or ovine or monkey or monkeys or trout or marmoset$1 or canine or dog or dogs or feline or cat or cats or zebrafish).ti

36. 34 or 35

37. 31 not 36

38. limit 37 to english language

Embase

Ovid Embase 1974 to 2021 August 19

1. bariatric*.mp. or exp bariatric surgery/

2. exp biliopancreatic bypass/ or (biliopancreatic diversion* or biliopancreatic bypass).mp

3. duodenal switch*.mp

4. (gastric bypass* or gastric surger*).mp

5. exp gastroenterostomy/ or gastroenterostom*.mp

6. gastrogastrostom*.mp

7. gastrojejunostom*.mp

8. gastroileal bypass.mp

9. gastroplast*.mp

10. intestin* bypass.mp. or exp jejunoileal bypass/

11. ((jejunoileal or jejuno-ileal or jejunoilial or jejuno-ilial or jejunocolic) adj bypass).mp

12. mason* procedure*.mp

13. ((obesity or obese or weight) adj5 surg*).mp

14. exp obesity/su [Surgery]

15. restrictive surger*.mp

16. roux-en-y.mp. or exp Roux Y anastomosis/

17. scopinaro.mp

18. sleeve gastrectom*.mp

19. ((stomach or gastric) adj5 stapl*).mp

20. (SADI or SADI-S or single anastomosis duodeno*).mp

21. or/1-20

22. (Abstral or Actiq or Alfentanil or Anexsia or Astramorph or Avinza or buprenorphine or Butrans or carfentan* or Codeine or Co-Gesic or Demerol or dextropropoxyphene or Diamorphine or Dilaudid or Dolophine or Duragesic or Embeda or Endocet or Exalgo or Fentanyl or Fentora or heroin or Hycet or Hycodan or Hydrocodone or Hydromet or hydromorphone or Hysingla or Ibudone or Kadian or levorphanol or levopropoxyphene or Liquicet or Lorcet or Lortab or Maxidone or meperidine or Morphabond or morphine or MS Contin or Nalbuphine or narcotic* or Norco or Nubain or Nucynta ER or Opana ER or opiate* or opioid* or opium or Onsolis or Oramorph or Ora-Morph or Oxaydo or Oxecta or Oxycet or oxycodone or OxyContin or Oxymorphone hydrochloride or Palladone or Pentazocine or Percocet or Percodan or Pethidine or Reprexain or Rezira or Roxanol* or Roxicet or Roxicodone or Roxycodone or Sublimaze or Sufentanil or tapentadol or Targiniq ER or tramacet or tramadol or TussiCaps or Tussionex or Tuzistra XR or Vicodin or Vicoprofen or Vituz or Xartemis XR or Xodol or Xtampza ER or Zohydro ER or Zolvit or Zutripro or Zydone).ti,ab,kw

23. exp *opiate addiction/

24. exp *narcotic analgesic agent/

25. or/22-24

26. (post-operative* or postoperative* or post-surg* or postsurg*).mp

27. ((post or after or follow*) adj3 (operat* or surg* or procedur* or gastrectom* or roux-en-y or bypass or gastric or sleeve)).mp

28. postoperative pain/

29. postoperative complication/

30. or/26-29

31. 21 and 25 and 30

32. animal/

33. human/

34. 32 not (32 and 33)

35. (veterinary or rabbit or rabbits or animal or animals or mouse or mice or rodent or rodents or rat or rats or murine or hamster* or pig or pigs or piglets or swine or porcine or horse* or equine or cow or cows or cattle or bovine or goat or goats or sheep or lambs or ovine or monkey or monkeys or trout or marmoset$1 or canine or dog or dogs or feline or cat or cats or zebrafish).ti

36. 34 or 35

37. 31 not 36

38. limit 37 to english language

Scopus

(TITLE-ABS-KEY ((obesity OR obese OR weight) W/4 surg*) OR TITLE-ABS-KEY (bariatric* OR "biliopancreatic diversion*" OR "biliopancreatic bypass" OR "duodenal switch*" OR "gastric band*" OR "gastric bypass*" OR "gastric surger*" OR gastroenterostom* OR gastrogastrostom* OR gastrojejunostom* OR "gastroileal bypass" OR gastroplast* OR "intestin* bypass" OR "jejunoileal bypass" OR "jejuno-ileal bypass" OR "jejunoilial bypass" OR "jejuno-ilial bypass" OR "jejunocolic bypass" OR "lap band*" OR "mason* procedure" OR "roux-en-y" OR "silicon band*" OR scopinaro OR "sleeve gastrectom*" OR sadi OR sadi-s OR "single anastomosis duodeno*") OR TITLE-ABS-KEY ((stomach OR gastric) W/4 stapl*)) AND TITLE-ABS-KEY (abstral OR actiq OR alfentanil OR anexsia OR astramorph OR avinza OR buprenorphine OR butrans OR carfentan* OR codeine OR co-gesic OR demerol OR dextropropoxyphene OR diamorphine OR dilaudid OR dolophine OR duragesic OR embeda OR endocet OR exalgo OR fentanyl OR fentora OR heroin OR hycet OR hycodan OR hydrocodone OR hydromet OR hydromorphone OR hysingla OR ibudone OR kadian OR levorphanol OR levopropoxyphene OR liquicet OR lorcet OR lortab OR maxidone OR meperidine OR morphabond OR morphine OR "MS Contin" OR nalbuphine OR narcotic* OR norco OR nubain OR "Nucynta ER" OR "Opana ER" OR opiate* OR opioid* OR opium OR onsolis OR oramorph OR ora-morph OR oxaydo OR oxecta OR oxycet OR oxycodone OR oxycontin OR "oxymorphone hydrochloride" OR palladone OR pentazocine OR percocet OR percodan OR pethidine OR reprexain OR rezira OR roxanol* OR roxicet OR roxicodone OR roxycodone OR sublimaze OR sufentanil OR tapentadol OR "Targiniq ER" OR tramacet OR tramadol OR tussicaps OR tussionex OR "Tuzistra XR" OR vicodin OR vicoprofen OR vituz OR "Xartemis XR" OR xodol OR "Xtampza ER" OR "Zohydro ER" OR zolvit OR zutripro OR zydone) AND TITLE-ABS-KEY (post-operative* OR postoperative* OR post-surg* OR postsurg* OR ( post W/3 ( operat* OR surg* OR procedur* OR gastrectom* OR roux-en-y OR bypass OR gastric OR sleeve)) OR ( after W/3 ( operat* OR surg* OR procedur* OR gastrectom* OR roux-en-y OR bypass OR gastric OR sleeve)) OR (follow* W/3 ( operat* OR surg* OR procedur* OR gastrectom* OR roux-en-y OR bypass OR gastric OR sleeve))) AND NOT TITLE (veterinary OR rabbit OR rabbits OR animal OR animals OR mouse OR mice OR rodent OR rodents OR rat OR rats OR murine OR hamster* OR pig OR pigs OR piglets OR swine OR porcine OR horse* OR equine OR cow OR cows OR cattle OR bovine OR goat OR goats OR sheep OR lambs OR ovine OR monkey OR monkeys OR trout OR marmoset$1 OR canine OR dog OR dogs OR feline OR cat OR cats OR zebrafish) AND ( LIMIT-TO (LANGUAGE, "English"))

Web of Science Core Collection

(TS = ((obesity OR obese OR weight) NEAR/4 surg*) OR TS = (bariatric* OR "biliopancreatic diversion*" OR "biliopancreatic bypass" OR "duodenal switch*" OR "gastric band*" OR "gastric bypass*" OR "gastric surger*" OR gastroenterostom* OR gastrogastrostom* OR gastrojejunostom* OR "gastroileal bypass" OR gastroplast* OR "intestin* bypass" OR "jejunoileal bypass" OR "jejuno-ileal bypass" OR "jejunoilial bypass" OR "jejuno-ilial bypass" OR "jejunocolic bypass" OR "lap band*" OR "mason* procedure" OR "roux-en-y" OR "silicon band*" OR scopinaro OR "sleeve gastrectom*" OR sadi OR sadi-s OR "single anastomosis duodeno*") OR TS = ((stomach OR gastric) NEAR/4 stapl*)) AND TS = (abstral OR actiq OR alfentanil OR anexsia OR astramorph OR avinza OR buprenorphine OR butrans OR carfentan* OR codeine OR co-gesic OR demerol OR dextropropoxyphene OR diamorphine OR dilaudid OR dolophine OR duragesic OR embeda OR endocet OR exalgo OR fentanyl OR fentora OR heroin OR hycet OR hycodan OR hydrocodone OR hydromet OR hydromorphone OR hysingla OR ibudone OR kadian OR levorphanol OR levopropoxyphene OR liquicet OR lorcet OR lortab OR maxidone OR meperidine OR morphabond OR morphine OR "MS Contin" OR nalbuphine OR narcotic* OR norco OR nubain OR "Nucynta ER" OR "Opana ER" OR opiate* OR opioid* OR opium OR onsolis OR oramorph OR ora-morph OR oxaydo OR oxecta OR oxycet OR oxycodone OR oxycontin OR "oxymorphone hydrochloride" OR palladone OR pentazocine OR percocet OR Percodan OR Pethidine OR reprexain OR rezira OR roxanol* OR roxicet OR roxicodone OR roxycodone OR sublimaze OR sufentanil OR tapentadol OR "Targiniq ER" OR tramacet OR tramadol OR tussicaps OR tussionex OR "Tuzistra XR" OR vicodin OR vicoprofen OR vituz OR "Xartemis XR" OR xodol OR "Xtampza ER" OR "Zohydro ER" OR zolvit OR zutripro OR zydone) AND TS = (post-operative* OR postoperative* OR post-surg* OR postsurg* OR ( post NEAR/3 ( operat* OR surg* OR procedur* OR gastrectom* OR roux-en-y OR bypass OR gastric OR sleeve)) OR (after NEAR/3 (operat* OR surg* OR procedur* OR gastrectom* OR roux-en-y OR bypass OR gastric OR sleeve)) OR ( follow* NEAR/3 (operat* OR surg* OR procedur* OR gastrectom* OR roux-en-y OR bypass OR gastric OR sleeve))) NOT TI = (veterinary OR rabbit OR rabbits OR animal OR animals OR mouse OR mice OR rodent OR rodents OR rat OR rats OR murine OR hamster* OR pig OR pigs OR piglets OR swine OR porcine OR horse* OR equine OR cow OR cows OR cattle OR bovine OR goat OR goats OR sheep OR lambs OR ovine OR monkey OR monkeys OR trout OR marmoset$1 OR canine OR dog OR dogs OR feline OR cat OR cats OR zebrafish)

Languages: English

Cochrane Library via Wiley

#1 bariatric*

#2 MeSH descriptor: [Bariatric Surgery] 2 tree(s) exploded

#3 MeSH descriptor: [Biliopancreatic Diversion] explode all trees

#4 biliopancreatic NEXT diversion*

#5 duodenal NEXT switch*

#6 (gastric NEXT band*) or (gastric NEXT bypass*) or (gastric NEXT surger*)

#7 MeSH descriptor: [Gastroenterostomy] explode all trees

#8 gastroenterostom*

#9 gastrogastrostom*

#10 gastrojejunostom*

#11 gastroileal bypass

#12 gastroplast*

#13 MeSH descriptor: [Jejunoileal Bypass] 4 tree(s) exploded

#14 intestin* NEXT bypass

#15 ((jejunoileal or jejuno-ileal or jejunoilial or jejuno-ilial or jejunocolic) NEAR/1 bypass)

#16 lap NEXT band*

#17 mason* NEXT procedure*

#18 ((obesity or obese or weight) NEAR/4 surg*)

#19 MeSH descriptor: [Obesity] explode all trees and with qualifier(s): [surgery – SU]

#20 restrictive NEXT surger*

#21 MeSH descriptor: [Anastomosis, Roux-en-Y] explode all trees

#22 roux-en-y

#23 scopinaro

#24 silicon NEXT band*

#25 sleeve NEXT gastrectom*

#26 ((stomach or gastric) NEAR/5 stapl*)

#27 SADI or SADI-S or single anastomosis duodeno*

#28 {OR #1-#27}

#29 Abstral or Actiq or Alfentanil or Anexsia or Astramorph or Avinza or buprenorphine or Butrans or carfentan* or Codeine or Co-Gesic or Demerol or dextropropoxyphene or Diamorphine or Dilaudid or Dolophine or Duragesic or Embeda or Endocet or Exalgo or Fentanyl or Fentora or heroin or Hycet or Hycodan or Hydrocodone or Hydromet or hydromorphone or Hysingla or Ibudone or Kadian or levorphanol or levopropoxyphene or Liquicet or Lorcet or Lortab or Maxidone or meperidine or Morphabond or morphine or MS Contin or Nalbuphine or narcotic* or Norco or Nubain or Nucynta ER or Opana ER or opiate* or opioid* or opium or Onsolis or Oramorph or Ora-Morph or Oxaydo or Oxecta or Oxycet or oxycodone or OxyContin or Oxymorphone hydrochloride or Palladone or Pentazocine or Percocet or Percodan or Pethidine or Reprexain or Rezira or Roxanol* or Roxicet or Roxicodone or Roxycodone or Sublimaze or Sufentanil or tapentadol or Targiniq ER or tramacet or tramadol or TussiCaps or Tussionex or Tuzistra XR or Vicodin or Vicoprofen or Vituz or Xartemis XR or Xodol or Xtampza ER or Zohydro ER or Zolvit or Zutripro or Zydone

#30 [mh "Opioid-Related Disorders"]

#31 [mh "Analgesics, Opioid"]

#32 {OR #29-#31}

#33 post-operative* or postoperative* or post-surg* or postsurg*

#34 ((post or after or follow*) NEAR/3 (operat* or surg* or procedur* or gastrectom* or roux-en-y or bypass or gastric or sleeve))

#35 [mh "Pain, Postoperative"]

#36 [mh "Postoperative Complications"]

#37 {OR #33-#36}

#38 #28 AND #32 AND #37

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(bariatric surgery OR sleeve gastrectomy OR roux-en-y OR gastric bypass) AND (opioid OR opiate OR analgesic) AND (post-surgery OR post-operative OR after surgery)

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Nasser, K., Verhoeff, K., Mocanu, V. et al. New persistent opioid use after bariatric surgery: a systematic review and pooled proportion meta-analysis. Surg Endosc 37, 703–714 (2023). https://doi.org/10.1007/s00464-022-09291-x

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  • DOI: https://doi.org/10.1007/s00464-022-09291-x

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