Impact of preoperative opioid use on health outcomes after bariatric surgery

Abstract

Background: Opioid consumption in North America has risen to alarming levels and represents a potentially modifiable risk factor in perioperative management. Chronic pain and obesity are commonly associated and bariatric surgery remains the most effective intervention for weight loss in morbidly obese patients.

Objectives: To understand how preoperative opioid use impacts surgical outcomes in patients undergoing bariatric surgery.

Setting: The Ontario Bariatric Registry.

Methods: Data collected in the Ontario Bariatric Registry between 2010 and 2018 were used for this retrospective study. Preoperative opioid use was retrospectively retrieved from the medication review during preoperative assessment. Primary outcomes were complications and readmissions at 30 and 90 days of surgery. Secondary outcomes included hospital length of stay and complication types at 30 and 90 days. Analyses were risk-adjusted for procedure type and patient-specific risk factors, such as age, sex, race, body mass index, and co-morbid conditions.

Results: Overall, 5357 patients were included in the study. Among those, 12% (n = 643) used opioids preoperatively. Risk-adjusted analyses demonstrated that opioid users, compared with opioid-naïve patients, had a longer length of stay (odds ratio: 2.50, 95% confidence interval: 1.05-6.00, P < .05) and higher rates of complications at 30 days (odds ratio: 1.40, 95% confidence interval: 1.02-2.18, P < .05). Subgroup analyses revealed that within preoperative opioid users, patients who underwent Roux-en-Y gastric bypass had poorer outcomes than those who underwent sleeve gastrectomy.

Conclusion: Opioid use is common before bariatric surgery and is independently associated with prolonged length of stay and complication rates at 30 days. Preoperative opioid use represents a potentially modifiable risk factor and a unique target to improving the quality of surgical care.

Keywords: Bariatric surgery; Opioids; Postoperative outcomes; Roux-en-Y gastric bypass; Sleeve gastrectomy.