Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Department of Surgery, Dvorkin Lounge Mailroom 2G2 Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 ST NW, Edmonton, AB, T6G 2B7, Canada.
Surg Endosc. 2023 Jan;37(1):62-74. doi: 10.1007/s00464-022-09481-7. Epub 2022 Aug 4.
A paucity of literature exists regarding current opioid prescribing and use following bariatric surgery. We aimed to characterize opioid prescribing practices and use following bariatric surgery to inform future studies and optimized prescribing practices.
We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and Cochrane Library (via WILEY) on August 20, 2021. Two reviewers reviewed and extracted data independently. Studies evaluating adult patients undergoing bariatric surgery that reported opioid prescriptions at discharge were included. Abstracts, non-English studies, and those with n < 5 were excluded. Primary outcomes assessed the amount of morphine milligram equivalents (MMEs) prescribed at discharge. Secondary outcomes evaluated opioids used following discharge, proportion of patients with unused opioid, and if unused opioids were properly discarded.
We evaluated 2113 studies, with 18 undergoing full-text review, and 5 meeting inclusion criteria. Overall, 847 patients were included, with 450 (53%) undergoing sleeve gastrectomy and 393 (46%) receiving Roux-en-Y gastric bypass. Most patients were female (n = 484/589, 82.2%), and the average age and BMI were 44.6 (± 11.8) years and 48.1 kg/m (± 8.4 kg/m), respectively. On average, 348.4 MMEs were prescribed to patients undergoing bariatric surgery. Patients used only 84.7 MMEs, with 87.0% (95% CI 66.0-99.0%) having unused opioid, and 41/120 (34.2%) retaining these excess opioids.
Nearly 90% of all bariatric patients evaluated in our systematic review are prescribed excessive opioids at discharge. Further work characterizing current opioid prescribing practices and use may help guide development of standardized post-bariatric surgery prescription guidelines.
关于减重手术后当前阿片类药物的开具和使用，文献资料有限。我们旨在描述减重手术后阿片类药物的开具和使用情况，以为未来的研究和优化的处方实践提供信息。
我们于 2021 年 8 月 20 日在 Ovid MEDLINE、Ovid Embase、Scopus、Web of Science 核心合集和 Cochrane Library（通过 WILEY）进行了系统评价。两名审查员独立进行了审查和提取数据。纳入评估接受减重手术的成年患者并在出院时报告阿片类药物处方的研究。排除摘要、非英语研究以及 n<5 的研究。主要结局评估出院时开具的吗啡毫克当量（MME）数量。次要结局评估出院后使用的阿片类药物、未使用阿片类药物的患者比例以及未使用的阿片类药物是否被妥善丢弃。
我们评估了 2113 项研究，其中 18 项进行了全文审查，5 项符合纳入标准。共有 847 名患者入组，其中 450 名（53%）接受袖状胃切除术，393 名（46%）接受 Roux-en-Y 胃旁路术。大多数患者为女性（n=484/589，82.2%），平均年龄和 BMI 分别为 44.6（±11.8）岁和 48.1kg/m（±8.4kg/m）。平均向接受减重手术的患者开具 348.4 MME 的阿片类药物。患者仅使用 84.7 MME，90%（95%CI 66.0-99.0%）的患者有未使用的阿片类药物，41/120（34.2%）保留了这些多余的阿片类药物。
我们的系统评价中评估的近 90%的减重患者出院时开具了过量的阿片类药物。进一步描述当前阿片类药物开具和使用情况的工作可能有助于指导制定标准化的减重手术后处方指南。
