Skip to main content

Advertisement

SpringerLink
Log in

Opioid prescribing practices following bariatric surgery: a systematic review and pooled proportion meta-analysis

  • Review Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

A paucity of literature exists regarding current opioid prescribing and use following bariatric surgery. We aimed to characterize opioid prescribing practices and use following bariatric surgery to inform future studies and optimized prescribing practices.

Methods and Procedure

We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and Cochrane Library (via WILEY) on August 20, 2021. Two reviewers reviewed and extracted data independently. Studies evaluating adult patients undergoing bariatric surgery that reported opioid prescriptions at discharge were included. Abstracts, non-English studies, and those with n < 5 were excluded. Primary outcomes assessed the amount of morphine milligram equivalents (MMEs) prescribed at discharge. Secondary outcomes evaluated opioids used following discharge, proportion of patients with unused opioid, and if unused opioids were properly discarded.

Results

We evaluated 2113 studies, with 18 undergoing full-text review, and 5 meeting inclusion criteria. Overall, 847 patients were included, with 450 (53%) undergoing sleeve gastrectomy and 393 (46%) receiving Roux-en-Y gastric bypass. Most patients were female (n = 484/589, 82.2%), and the average age and BMI were 44.6 (± 11.8) years and 48.1 kg/m2 (± 8.4 kg/m2), respectively. On average, 348.4 MMEs were prescribed to patients undergoing bariatric surgery. Patients used only 84.7 MMEs, with 87.0% (95% CI 66.0–99.0%) having unused opioid, and 41/120 (34.2%) retaining these excess opioids.

Conclusion

Nearly 90% of all bariatric patients evaluated in our systematic review are prescribed excessive opioids at discharge. Further work characterizing current opioid prescribing practices and use may help guide development of standardized post-bariatric surgery prescription guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL (2017) Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg 152:1066–1071. https://doi.org/10.1001/JAMASURG.2017.0831

    Article  Google Scholar 

  2. Smith ME, Lee JS, Bonham A, Varban OA, Finks JF, Carlin AM, Ghaferi AA (2019) Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery. Surg Endosc 33:2649–2656. https://doi.org/10.1007/s00464-018-6542-0

    Article  Google Scholar 

  3. King WC, Chen JY, Belle SH, Courcoulas AP, Dakin GF, Flum DR, Hinojosa MW, Kalarchian MA, Mitchell JE, Pories WJ, Spaniolas K, Wolfe BM, Yanovski SZ, Engel SG, Steffen KJ (2017) Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surg Obes Relat Dis 13:1337–1346. https://doi.org/10.1016/J.SOARD.2017.04.003

    Article  Google Scholar 

  4. Raebel MA, Newcomer SR, Bayliss EA, Boudreau D, DeBar L, Elliott TE, Ahmed AT, Pawloski PA, Fisher D, Toh S, Donahoo WT (2014) Chronic opioid use emerging after bariatric surgery. Pharmacoepidemiol Drug Saf 23:1247–1257. https://doi.org/10.1002/pds.3625

    Article  Google Scholar 

  5. Wallen S, Szabo E, Palmetun-Ekback M, Naslund I (2018) Use of opioid analgesics before and after gastric bypass surgery in sweden: a population-based study. Obes Surg 28:3518–3523. https://doi.org/10.1007/s11695-018-3377-7

    Article  Google Scholar 

  6. Nasser K, Verhoeff K, Mocanu V, Kung JY, Purich K, Switzer NJ, Birch DW, Karmali S (2022) New persistent opioid use after bariatric surgery: a systematic review and pooled proportion meta-analysis. Surg Endosc 2022:1–12. https://doi.org/10.1007/S00464-022-09291-X

    Article  Google Scholar 

  7. Dowell D, Haegerich TM, Chou R (2016) CDC guideline for prescribing opioids for chronic pain-United States, 2016. JAMA 315:1624–1645. https://doi.org/10.1001/JAMA.2016.1464

    Article  CAS  Google Scholar 

  8. Bleicher J, Stokes SM, Brooke BS, Glasgow RE, Huang LC (2021) Patient-centered opioid prescribing: breaking away from one-size-fits-all prescribing guidelines. J Surg Res 264:1–7. https://doi.org/10.1016/j.jss.2021.01.048

    Article  Google Scholar 

  9. Ehlers AP, Sullivan KM, Stadeli KM, Monu JI, Chen-Meekin JY, Khandelwal S (2020) Opioid use following bariatric surgery: results of a prospective survey. Obes Surg 30:1032–1037. https://doi.org/10.1007/s11695-019-04301-9

    Article  Google Scholar 

  10. Ford J, Kindel T, Higgins RM, Lak KL, Hetzel E, Gould JC (2021) Examining current patterns of opioid prescribing and use after bariatric surgery. Surg Endosc. https://doi.org/10.1007/s00464-021-08544-5

    Article  Google Scholar 

  11. Howard R, Alameddine M, Klueh M, Englesbe M, Brummett C, Waljee J, Lee J (2018) Spillover effect of evidence-based postoperative opioid prescribing. J Am Coll Surg 227:374–381. https://doi.org/10.1016/j.jamcollsurg.2018.06.007

    Article  Google Scholar 

  12. Friedman DT, Ghiassi S, Hubbard MO, Duffy AJ (2019) Postoperative opioid prescribing practices and evidence-based guidelines in bariatric surgery. Obes Surg 29:2030–2036. https://doi.org/10.1007/s11695-019-03821-8

    Article  Google Scholar 

  13. Angeles PC, Robertsen I, Seeberg LT, Krogstad V, Skattebu J, Sandbu R, Åsberg A, Hjelmesæth J (2019) The influence of bariatric surgery on oral drug bioavailability in patients with obesity: a systematic review. Obes Rev 20:1299. https://doi.org/10.1111/OBR.12869

    Article  Google Scholar 

  14. Brutman JN, Sirohi S, Davis JF (2019) Recent advances in the neurobiology of altered motivation following bariatric surgery. Curr Psychiatry Rep. https://doi.org/10.1007/S11920-019-1084-2

    Article  Google Scholar 

  15. Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J (2008) Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 107:138–143. https://doi.org/10.1213/ANE.0B013E318174DF8B

    Article  Google Scholar 

  16. Jones T, Moore T, Levy JL, Daffron S, Browder JH, Allen L, Passik SD (2012) A comparison of various risk screening methods in predicting discharge from opioid treatment. Clin J Pain 28:93–100. https://doi.org/10.1097/AJP.0B013E318225DA9E

    Article  Google Scholar 

  17. Haddaway NR, Collins AM, Coughlin D, Kirk S (2015) The role of google scholar in evidence reviews and its applicability to grey literature searching. PLoS ONE 10:e0138237. https://doi.org/10.1371/JOURNAL.PONE.0138237

    Article  Google Scholar 

  18. Estimate of Bariatric Surgery Numbers, 2011–2019 | American Society for Metabolic and Bariatric Surgery. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 10 Feb 2022

  19. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Calculating Total Daily Dose of Opioids for Safer Dosage. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed 10 Feb 2022

  20. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/J.1445-2197.2003.02748.X

    Article  Google Scholar 

  21. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:1–13. https://doi.org/10.1186/1471-2288-14-135/TABLES/3

    Article  Google Scholar 

  22. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/BMJ.327.7414.557

    Article  Google Scholar 

  23. Heinberg LJ, Pudalov L, Alameddin H, Steffen K (2019) Opioids and bariatric surgery: a review and suggested recommendations for assessment and risk reduction. Surg Obes Relat Dis 15:314–321. https://doi.org/10.1016/J.SOARD.2018.11.019

    Article  Google Scholar 

  24. Varady NH, Chen AF, Niu R, Chung M, Freccero DM, Smith EL (2021) Association between surgical opioid prescriptions and opioid initiation by opioid-naïve spouses. Ann Surg. https://doi.org/10.1097/SLA.0000000000005350

    Article  Google Scholar 

  25. Stone AA, Broderick JE (2012) Obesity and pain are associated in the United States. Obesity (Silver Spring) 20:1491–1495. https://doi.org/10.1038/OBY.2011.397

    Article  Google Scholar 

  26. Raebel MA, Newcomer SR, Reifler LM, Boudreau D, Elliott TE, DeBar L, Ahmed A, Pawloski PA, Fisher D, Donahoo WT, Bayliss EA (2013) Chronic use of opioid medications before and after bariatric surgery. JAMA 310:1369–1376. https://doi.org/10.1001/JAMA.2013.278344

    Article  CAS  Google Scholar 

  27. Falconer EA, Harris DA, van Prooyen A, Hicks J, Singh A, Davis SS Jr, Lin E, Sharma J, Pollock J, Samarov Dv, Hechenbleikner EM (2021) Pharmacy-led initiative for improving peri-operative medication reconciliation among bariatric surgical patients: what is the role? Surg Endosc. https://doi.org/10.1007/s00464-021-08343-y

    Article  Google Scholar 

  28. Hallway A, Howard R, Vu J, Santos-Parker J, Waljee J, Brummett CM, Englesbe M (2019) Optimizing postoperative opioid prescribing through quality-based reimbursement. JAMA Netw Open 2:e1911619. https://doi.org/10.1001/jamanetworkopen.2019.11619

    Article  Google Scholar 

  29. Pardue B, Thomas A, Buckley J, Suggs WJ (2020) An opioid-sparing protocol improves recovery time and reduces opioid use after laparoscopic sleeve gastrectomy. Obes Surg 30:4919–4925. https://doi.org/10.1007/s11695-020-04980-9

    Article  Google Scholar 

Download references

Funding

There is no funding or grant support for this study.

Author information

Authors and Affiliations

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

    Andrea Lin, Valentin Mocanu, Kieran Purich & Noah J. Switzer

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

    Kevin Verhoeff

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

    Khadija Nasser

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

    Janice Y. Kung

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

    Daniel W. Birch & Shahzeer Karmali

Authors
  1. Andrea Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin Verhoeff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentin Mocanu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kieran Purich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khadija Nasser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Janice Y. Kung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel W. Birch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shahzeer Karmali
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Noah J. Switzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin Verhoeff.

Ethics declarations

Disclosure

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

Ethical approval

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.”

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 37 kb)

Supplementary file2 (DOCX 109 kb)

Appendix

Appendix

See Table 5.

Table 5 Search strategies
Full size table

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, A., Verhoeff, K., Mocanu, V. et al. Opioid prescribing practices following bariatric surgery: a systematic review and pooled proportion meta-analysis. Surg Endosc 37, 62–74 (2023). https://doi.org/10.1007/s00464-022-09481-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09481-7

Keywords

Search

Navigation