Bariatric surgery patients at risk for opioid addiction
Patients who undergo bariatric surgery have a higher risk for developing new persistent opioid use compared with patients who undergo other elective surgeries, according to research presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery.
Additionally, Amir A. Ghaferi, MD, MS, associate professor of surgery and business at the University of Michigan and director of the Michigan Bariatric Surgery Collaborative, and colleagues said their research revealed several other short- and long-term complications for these patients beyond the direct adverse effects of opioid use.
“This is the first study to comprehensively evaluate the clinical consequences of new persistent opioid use in bariatric surgery patients,” Ghaferi told Healio Gastroenterology and Liver Disease. “In fact, there have been no studies to date looking at clinical outcomes in new persistent users compared to those who are not following surgery. We were able to not only evaluate perioperative outcomes, but also longitudinal outcomes at one year postoperatively.”
Using a cohort of 25,103 patients who underwent primary, non-revisional bariatric surgery between 2006 and 2016, Ghaferi and colleagues determined the risk for new persistent opioid use by assessing opioid use at baseline and at follow-up one year after surgery.
The researchers found that of the 78.5% of patients who denied opioid use at baseline (n = 19,706), 8% (n = 1,577) reported new persistent opioid use one year after their bariatric surgery. In comparison, they noted that approximately 6% of patients develop new persistent opioid use after elective surgery in general.
When compared with opioid naive patients after accounting for baseline demographic and comorbidity differences, patients with new persistent opioid use were more likely to experience postoperative complication after bariatric surgery (9.4% vs. 6.1%; P < .001). New persistent users also lost significantly less weight in the year following surgery based on percentage of excess body weight lost (57.6% vs. 60.3%; P < .001).
Ghaferi and colleagues said more effort should be put behind identifying patients with prolonged or excessive opioid use following bariatric surgery, particularly because of concerns for addiction transfer.
“The most important takeaway here is we have excellent strategies to limit postoperative opioid use,” Ghaferi said. “We now know these efforts can significantly increase long-term patient well-being and the efficacy of our operations." – by Alex Young
Ghaferi AA, et al. Abstract S136. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery; April 11-14; Seattle, WA.
Disclosures: Ghaferi reports receiving salary support from Blue Cross Blue Shield of Michigan.