Long-term opioid use after bariatric surgery

Matthew L Maciejewski; Valerie A Smith; Theodore S Z Berkowitz; David E Arterburn; Katharine A Bradley; Maren K Olsen; Chuan-Fen Liu; Edward H Livingston; Luke M Funk; James E Mitchell

doi:10.1016/j.soard.2020.04.037

Long-term opioid use after bariatric surgery

Surg Obes Relat Dis. 2020 Aug;16(8):1100-1110. doi: 10.1016/j.soard.2020.04.037. Epub 2020 May 7.

Authors

Affiliations

¹ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina. Electronic address: matthew.maciejewski@va.gov.
² Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.
³ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.
⁴ Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
⁵ Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington.
⁶ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
⁷ Department of Health Services, University of Washington, Seattle, Washington.
⁸ Veterans Administration North Texas Healthcare System, Dallas, Texas; Department of Surgery, University of California at Los Angeles, Los Angeles, California; Division of General Surgery, Northwestern University, Evanston, Illinois; Journal of the American Medical Association, Chicago, Illinois.
⁹ Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin.
¹⁰ University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.

Abstract

Background: Opioid analgesics are often prescribed to manage pain after bariatric surgery, which may develop into chronic prescription opioid use (CPOU) in opioid-naïve patients. Bariatric surgery may affect opioid use in those with or without presurgical CPOU.

Objective: To compare CPOU persistence and incidence in a large multisite cohort of veterans undergoing bariatric surgery (open Roux-en-Y gastric bypass, laparoscopic RYGB, or laparoscopic sleeve gastrectomy) and matched nonsurgical controls.

Setting: Veterans Administration hospitals.

Methods: In a retrospective cohort study, we matched 1117 surgical patients with baseline CPOU to 9531 nonsurgical controls, and 2822 surgical patients without CPOU at baseline to 26,392 nonsurgical controls using sequential stratification. CPOU persistence in veterans with baseline CPOU was estimated using generalized estimating equations by procedure type. CPOU incidence in veterans without baseline CPOU was estimated in Cox regression models by procedure type because postoperative pain, complications, and absorption may differ by procedure.

Results: In veterans with baseline CPOU, postsurgical CPOU declined over time for each surgical procedure; these trends did not differ between surgical patients and nonsurgical controls. In veterans without baseline CPOU, compared with nonsurgical controls, bariatric patients had higher CPOU incidence within 5 years after open Roux-en-Y gastric bypass (hazard ratio = 1.19; 95% confidence interval: 1.06-1.34) or laparoscopic open Roux-en-Y gastric bypass (hazard ratio = 1.22, 95% confidence interval: 1.06-1.41). Veterans undergoing laparoscopic sleeve gastrectomy had higher CPOU incidence 1 to 5 years after surgery (hazard ratio = 1.28; 95% confidence interval: 1.05-1.56) than nonsurgical controls.

Conclusions: Bariatric surgery was associated with greater risk of CPOU incidence in patients without baseline CPOU but was not associated with greater CPOU persistence.

Keywords: Bariatric; Gastric bypass; Matching; Medication; Obesity; Opioid; Sleeve gastrectomy; Surgery; Veterans.

Published by Elsevier Inc.

MeSH terms

Analgesics, Opioid / therapeutic use
Bariatric Surgery*
Gastrectomy
Gastric Bypass* / adverse effects
Humans
Laparoscopy*
Obesity, Morbid* / surgery
Retrospective Studies
Weight Loss

Substances

Analgesics, Opioid

Abstract

MeSH terms

Substances

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