Background

Background: New persistent opioid use following bariatric surgery is associated with worse outcomes and lower patient satisfaction. 10% of opioid naïve patients report new persistent opioid use one year after bariatric surgery (vs 6% of general surgery patients). The 3rd Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program aims to reduce the utilization of opioids with bariatric surgery. Objective: To present our experience as a newly accredited bariatric center for excellence using a multi-modal pain protocol to mitigate opioid utilization following bariatric surgery.

Methods

A retrospective analysis was performed of patients who underwent bariatric surgery at South Shore University Hospital (SSUH) from December 2019 – December 2021. Patients on chronic opioids 30 days preoperatively or who used narcotics within 7 days of surgery were excluded. A multi-modal pain protocol included preoperative education, non-opioid analgesics prior to induction, intraoperative avoidance of opioids, and postoperative use of nonopioids daily with opioids only for breakthrough pain. The mean morphine milligram equivalent (MME) per year used during inpatient, prescribed at discharge, and used outpatient was recorded. Patients were surveyed regarding satisfaction.

Results

126 opioid-naïve patients underwent bariatric surgery at SSUH. The mean MME used inpatient was 23.5 (2019-2020) and 22.15 (2020-2021). From 2020-2021, one patient received opioids in the PACU; 14 (16.5%) patients received 0 opioids while inpatient, including PACU. All patients were discharged without opioids. Patient satisfaction remained high.

Conclusions

Our institution was able to effectively minimize opioid utilization in opioid naïve patients following bariatric surgery using a multi-modal pain protocol.