Crumbley Mae, Petersen Sarah, Bonham Aaron J, Yang Phillip, Gururaj Ani, Deng Callie, Dennis Alexander, Carlin Arthur M, Varban Oliver A
University of Michigan Medical School, Ann Arbor, Michigan.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Surg Obes Relat Dis. 2025 Jun;21(6):619-626. doi: 10.1016/j.soard.2025.01.003. Epub 2025 Jan 22.
Efforts have been made to reduce opioid prescribing after metabolic-bariatric surgery (MBS) given the increased risk for misuse. Variation in prevalence of opioid-free discharge following MBS and its impact on outcomes remains unclear.
To evaluate variation in opioid prescribing practices after MBS and the impact of opioid-free discharge on outcomes.
MBS programs participating in a state-wide quality improvement collaborative.
Using a state-wide bariatric-specific data registry, all patients who underwent MBS between 2018 and 2023 and had opioid prescribing data were identified (n = 54,276). Patient characteristics and 30-day risk-adjusted outcomes were compared between patients who were and were not prescribed opioids at discharge. Surgeon and practice characteristics were also compared between the top and bottom quartiles of opioid-free discharge.
The prevalence of opioid-free discharge increased from 7.7% to 32.1% over the study period. Only .4% of patients, who were opioid-free at discharge, obtained an opioid prescription within 30 days of discharge. Opioid-free discharge was associated with lower rates of emergency department (ED) visits (7.7% vs 8.2%, P = .0008), despite similar complication rates (7.6% vs 7.3%, P = .7261). There were no significant differences in age, case volume, or practice types between surgeons in the top quartile and bottom quartile for opioid-free discharge.
Opioid-free discharge after MBS has increased in prevalence with extremely low failure rates without negatively impacting ED visit rates. Variation in opioid prescribing persists and may be due to patient-specific factors as well as surgeon-specific preference.
鉴于代谢减重手术（MBS）后阿片类药物滥用风险增加，人们已努力减少其处方量。MBS后无阿片类药物出院的发生率差异及其对结局的影响仍不明确。
评估MBS后阿片类药物处方实践的差异以及无阿片类药物出院对结局的影响。
参与全州质量改进协作的MBS项目。
利用全州特定于减重手术的数据登记处，识别出2018年至2023年间接受MBS且有阿片类药物处方数据的所有患者（n = 54276）。比较出院时开具和未开具阿片类药物的患者的特征及30天风险调整后的结局。还比较了无阿片类药物出院的前四分位数和后四分位数之间的外科医生及医疗机构特征。
在研究期间，无阿片类药物出院的发生率从7.7%增至32.1%。出院时无阿片类药物的患者中，只有0.4%在出院后30天内获得了阿片类药物处方。尽管并发症发生率相似（7.6%对7.3%，P = 0.7261），但无阿片类药物出院与较低的急诊科就诊率相关（7.7%对8.2%，P = 0.0008）。在无阿片类药物出院的前四分位数和后四分位数的外科医生之间，年龄、病例数量或医疗机构类型无显著差异。
MBS后无阿片类药物出院的发生率有所增加，失败率极低，且对急诊科就诊率无负面影响。阿片类药物处方存在差异，可能是由于患者特定因素以及外科医生特定偏好所致。
