Skip to main content
SpringerLink
Log in

Examining current patterns of opioid prescribing and use after bariatric surgery

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Evidence-based guidelines on the appropriate amount of opioid medications to prescribe following bariatric surgery are lacking. We sought to determine our current opioid-prescribing practices, patient utilization, and satisfaction with pain control following elective bariatric surgery.

Methods

A retrospective chart review and phone survey were conducted on patients who underwent laparoscopic or robotic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from April 2018 to March 2019 at a single academic medical center. Opioid medications were converted to morphine milligram equivalents provided (MMEs).

Results

In total, 192 patients met inclusion criteria. The median amount of opioid medication prescribed on discharge was 300 oral MMEs, although there was a significant difference between the MMEs prescribed to patients with and without chronic opioid therapy (median 300 MMEs opioid naïve vs. 375 MMEs chronic opioid therapy, p = 0.01). Significantly fewer SG patients required a refill of their opioid medication compared to RYGB (8.3% vs. 23.9%, p = 0.003). Of the 192 patients, 87 (45.3%) completed the phone survey. Fifty-six patients (64%) reported that they took half or less of the initially prescribed opioids. Of the patients with leftover medication, 36% reported that they did not dispose of the medication. Overall understanding of pain control options after surgery was significantly lower in patients who felt they were prescribed “too little” opioids (p = 0.01), patients requiring refills (p = 0.02), and patients who were not satisfied with their pain control (p = 0.02).

Conclusion

There is a gap between the amount of opioid medication prescribed and taken by patients following bariatric surgery in our practice. Patients who were least satisfied with their pain control reported knowledge gaps about pain control options that were more significant than patients who were more satisfied. Future initiatives should focus on the reduction of opioids prescribed to bariatric surgery patients post-operatively and on opioid education for patients.

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

Similar content being viewed by others

References

  1. Hedegaard H, Minino AM, Warner M (2020). Drug overdose deaths in the United States, 1999–2018. NCHS Data Brief, no 356. National Center for Health Statistics, Hyattsville

  2. Blay E Jr, Nooromid MJ, Bilimoria KY, Holl JL, Lambert B, Johnson JK, Stulberg JJ (2018) Variation in post-discharge opioid prescriptions among members of a surgical team. Am J Surg 216:25–30

    Article  Google Scholar 

  3. Linnaus ME, Sheaffer WW, Ali-Mucheru MN, Velazco CS, Neville M, Gray RJ (2018) The opioid crisis and surgeons: national survey of prescribing patterns and the influence of motivators, experience, and gender. Am J Surg 217:1116–1120

    Article  Google Scholar 

  4. Howard R, Fry B, Gunaseelan V, Lee J, Waljee J, Brummett C, Campbell D Jr, Seese E, Englesbe M, Vu J (2019) Association of opioid prescribing with opioid consumption after surgery in Michigan. JAMA Surg 154:1–8

    Article  Google Scholar 

  5. Brummett CM, Waljee JF, Goesling J et al (2017) New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152:1–9

    Article  Google Scholar 

  6. Hooten WM, St Sauver JL, McGree ME, Jacobson DJ, Warner DO (2015) Incidence and risk factors for progression from short-term to episodic or long-term opioid prescribing. Mayo Clin Proc 90:850–856

    Article  Google Scholar 

  7. Dayo RA, Hallvik SE, Hildebran C, Marino M, Dexter E, Irvine JM, O’Kane N, Van Otterloo J, Wright DA, Leichtling G, Millet LM (2017) Association between initial opioid prescribing patterns and subsequent long-term use among opioid-naïve patients: a statewide retrospective cohort study. J Gen Intern Med 32:21–27

    Article  Google Scholar 

  8. Dowell D, Haegerich TM, Chou R (2016) CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep 65(No. RR-1):1–49

    Article  Google Scholar 

  9. Centers for Disease Control and Prevention (2019) CDC guideline for prescribing opioids for chronic pain. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrived from https://www.cdc.gov/drugoverdose/prescribing/guideline.html

  10. 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

    Article  Google Scholar 

  11. Hill MV, Stucke RS, McMahon ML, Beeman JL, Barth RJ Jr (2018) An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg 267:468–472

    Article  Google Scholar 

  12. Mark J, Argentieri DM, Gutierrez CA et al (2018) Ultrarestrictive opioid prescription protocol for pain management after gynecologic and abdominal surgery. JAMA Netw Open 1:1–14

    Article  Google Scholar 

  13. Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ Jr (2018) Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg 226:996–1003

    Article  Google Scholar 

  14. Chen EY, Betancourt L, Li L, Trucks E, Marcantonio A, Tornetta P (2020) Standardized, patient-specific, postoperative opioid prescribing after inpatient orthopedic surgery. J Am Acad Orthop Surg 28:e304–e318

    Article  Google Scholar 

  15. Holte AJ, Carender CN, Noiseux NO, Otero JE, Brown TS (2019) Restrictive opioid prescribing protocols following total hip arthroplasty and total knee arthroplasty are safe and effective. J Arthroplast 34:s135–s139

    Article  Google Scholar 

  16. Hernandez MC, Finnesgard EJ, Aho JM, Zielinski MD, Schiller HJ (2020) Reduced opioid prescription practices and duration of stay after TAP block for laparoscopic appendectomy. J Gastrointest Surg 24:418–425

    Article  Google Scholar 

  17. Moon RC, Lastrapes L, Wier J, Nakajima M, Gaskins W, Teixeira AF, Jawad MA (2019) Preoperative transversus abdominis plane (TAP) block with liposomal bupivacaine for bariatric patients to reduce the use of opioid analgesics. Obes Surg 29:1099–1104

    Article  Google Scholar 

  18. Hamid HKS, Ahmed AY, Saber AA, Emile SH, Ibrahim M, Ruiz-Tovar J (2020) Transversus abdominis plane block using a short-acting local anesthetic reduces pain and opioid consumption after laparoscopic bariatric surgery: a meta-analysis. Surg Obes Relat Dis 16:1349–1357

    Article  Google Scholar 

  19. Wick EC, Grant MC, Wu CL (2017) Postoperative multimodal analgesia management with nonopioid analgesics and techniques. JAMA Surg 152:691–697

    Article  Google Scholar 

  20. Eckhard L, Jones T, Collins JE, Shrestha S, Fitz W (2018) Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:2167–2172

    Article  Google Scholar 

  21. Substance Abuse and Mental Health Services Administration (2020) Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville

    Google Scholar 

  22. Stokes SM, Kim RY, Jacobs A, Esplin J, Kwok AC, Varghese TK Jr, Glasgow RE, Brooke BS, Finlayson SRG, Huang LC (2020) Home disposal kits for leftover opioid medications after surgery: do they work? J Surg Res 245:396–402

    Article  CAS  Google Scholar 

  23. Buffington DE, Lozicki A, Alfieri T, Bond TC (2019) Understanding factors that contribute to the disposal of unused opioid medication. J Pain Res 12:725–732

    Article  Google Scholar 

  24. Varisco TJ, Fleming ML, Bapat SS, Wanat MA, Thornton D (2019) Health care practicioner counseling encourages disposal of unused opioid medications. J Am Pharm Assoc 59:809–815

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Jordanne Ford, Tammy Kindel, Rana M. Higgins, Kathleen L. Lak, Emily Hetzel & Jon C. Gould

Authors
  1. Jordanne Ford
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tammy Kindel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rana M. Higgins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathleen L. Lak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emily Hetzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jon C. Gould
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jon C. Gould.

Ethics declarations

Disclosure

Dr. Jon Gould is a consultant for Ethicon, Gore, and BD. Dr. Rana Higgins is a speaker and consultant for Gore and Intuitive. Jordanne Ford, Dr. Tammy Kindel, Emily Hetzel, and Dr. Kathleen Lak declare that they have no conflict of interest or financial ties to disclose.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ford, J., Kindel, T., Higgins, R.M. et al. Examining current patterns of opioid prescribing and use after bariatric surgery. Surg Endosc 36, 2564–2569 (2022). https://doi.org/10.1007/s00464-021-08544-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08544-5

Keywords

Search

Navigation