T. Mokharti1, A. Nair1, D. Azagury1, H. Rivas1, J. Morton1 1Stanford University,Bariatric And Minimally Invasive Surgery,Stanford, CALIFORNIA, USA
Introduction:
Long-term opioid use has recently increased. However, the interaction of opioid use as it relates to obese populations remains understudied. This study aims to investigate the effect of pre-operative use of opioid analgesics on weight loss outcomes, reoperation rates, readmission rates, and complication rates for patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and gastric banding (LB).
Methods:
A prospective cohort of 1139 patients undergoing bariatric surgery at a single academic institution was analyzed preoperatively, three-months, six-months, and twelve-months postoperatively. Patients were stratified into opioid analgesic users and non-opioid users based on narcotic questioning at the consult or preoperative visit. The effect of pre-operative opioid use on bariatric surgical outcomes was analyzed using Student t-test for continuous variables and chi-squared analysis for dichotomous variables. All data was analyzed using Stata/SE, 12.1.
Results:
Within the cohort of 1139 patients, 77.81% underwent RYGB (n = 866) 9.34% underwent LB (n=104) and 12.85% underwent SG (n= 143). Of the patient population, 105 patients were reported as having preoperative use of opioid medications. Patients on opioid medications had a 4.7% lower percent excess weight loss (%EWL) 12-months postoperatively compared to those not on opioid medications (70.35 %EWL vs. 65.69 %EWL, p = 0.035). However by surgical type, no statistically significant difference was found among RYGB and SG patients. LB patients on preoperative opioid analgesic medication were found to have a 16.6% decreased excess weight loss as compared to non-opioid users (44.04 %EWL vs. 27.44 %EWL, p = 0.021). No statistically significant differences between opioid analgesic users and non-users were found collectively or for the individual procedures for changes in BMI, reoperation incidence, readmission incidence, or incidence of post-surgical complications.
Conclusion:
Preoperative opioid analgesic use is a negative predictor for 12-month excess weight loss, particularly for patients undergoing laparoscopic adjustable gastric banding. These results indicate the need for thoughtful preoperative management of pain and opioid analgesics in bariatric patients to optimize surgical weight loss.