Gastric bypass patients at increased risk of prolonged opioid use
Swedish researchers have reported that Roux-en-Y gastric bypass (RYGB) surgery can significantly increase prolonged opioid use in patients with obesity who were non-consumers prior to surgery but had no effect on overall opioid use among prior consumers. They noted that post-RYGB associated surgery, requiring post-operative opioid treatment, may in part explain these findings. The findings were featured in the paper, ‘Opioid consumption in patients undergoing Roux-en-Y bariatric surgery compared with population controls with and without obesity’, published in SOARD.
In their study, researchers from Sahlgrenska University Hospital/Östra and the University of Gothenburg, Gothenburg, Sweden, sought to compare opioid consumption in patients with obesity who underwent RYGB with population controls with and without obesity, not undergoing bariatric surgery, and to identify characteristics associated with opioid use. All RYGB patients, controls with obesity, and population controls were classified as either consumers or non-consumers according to opioid consumption 12 months prior to study baseline (defined as individuals with at least one dispensing of a medication containing opioids 12 months prior to baseline and non-consumers defined as individuals without any dispensed medication containing opioids 12 months prior to baseline).
The study included 93,860 individuals; 23,898 RYGB patients, 23,898 were controls with obesity and 46,064 were population controls. The mean age was 39 (SD 10) years, 75% were female and 58–60% were single across the population.
During the 12 months prior to the study baseline, 23.7% of RYGB patients, 21.8% of the controls with obesity and 7.5% of the population controls were classified as consumers, with at least one dispensing containing an opioid. Of which 7.1%, 8.6% and 3.5% of RYGB patients, controls with obesity, and population controls, respectively, obtained a diagnostic code for pain. This was matched by the proportions of substance abusers, i.e., 6.9%, 9.5% and 4.4% for RYGB patients, controls with obesity, and population controls, respectively.
The proportion of individuals with psychiatric disorders prior to study baseline was slightly lower in the RYGB patients vs. the controls with obesity (16.3% vs 20.2%), but higher than among the population controls (16.3% vs 8.7%).
During 0–12 months, there was a higher proportion of individuals with at least one opioid dispensing among RYGB patients (44.6%) vs. controls with obesity (13.3%) and population controls (5.0%). From 13–24 months, there was still a significant difference in the proportion of prevalent opioid users between the RYGB patients (16.6%) and controls with obesity (14.3%) (p<.0001). In addition, there was a marked difference in the proportion of prevalent opioid users between RYGB patients and population controls (16.6% vs. 5.4%, p<.0001).
Interestingly, they noted that the proportion of RYGB patients using opioids decreased from 44.6% during 0–12 months after surgery, to 16.6% during 13–24 months after surgery.
Unsurprisingly, RYGB patients had higher incidence of explorative laparotomy (2.1%) compared with controls with obesity (0.3%) and population controls (0.0%). From these patients, 78% of non-consumers and 92% of consumers were prescribed opioid analgesia post-surgery. RYGB patients also had higher incidence of bowel obstruction surgery (1.9%) compared with controls with obesity (0.2%) and population controls (0%).
Out of these patients 70% of non-consumers and 86% of consumers were prescribed opioid analgesia post-surgery. More RYGB patients had cholecystectomy (0.7%) compared with controls with obesity (0.1%) and population controls (0.0%).
“We also find that a range of comorbidities linked to the obesity syndrome (i.e., pain, substance abuse, and psychiatric disorders) make the patient group with obesity in general more prone to prevalent opioid use compared to the general population without obesity,” the authors concluded. “With a globally growing number of patients with obesity presenting with previous or ongoing opioid-addiction3, the treatment of obesity-linked disorders should probably convert to more opioid-sparing care strategies.”
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