Preoperative chronic opioid use and its impact on early complications in bariatric surgery : a Swedish nationwide cohort study of 56,183 patients

• Background: The association between severe obesity and chronic pain makes opioid use common among bariatric patients. Preoperative opioid use has been identified as a risk factor in other surgical procedures.Objectives: To examine the impact of preoperative opioid use on complications after primary bariatric surgery.Setting: Sweden.Methods: All primary laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) patients from 2007-2017 were identified in the Scandinavian Obesity Surgery Register. Prescriptions for opioids within 90 days prior to surgery were retrieved from the Swedish Prescribed Drug Register and converted into oral morphine equivalents (OMEs). Patients with >= 2 prescription of opioids within 90 days prior to surgery were defined as chronic opioid users. Generalized linear regression was used to adjust for age, sex, body mass index, procedure type, year of operation, and co-morbidities.Results: Of the 56,183 patients who had undergone primary LRYGB (n = 49,615) or LSG (n = 6568), 17.5% (n = 9825) had at least 1 prescription of opioids prior to surgery, of which 4.3% (n = 2390) were defined as chronic opioid users. Chronic opioid use was associated with a higher risk of severe complications (Clavien Dindo grade >= 3b; odds ratio [OR], 1.67; 95% confidence interval [CI], 1.37-2.04), increased lengths of stay (relative risk, 1.11; 95% CI, 1.08-1.14), and higher rates of readmission (OR, 1.70; 95% CI, 1.49-1.94) and reoperation (OR, 1.87; 95% CI, 1.53-2.27; all P values < .001). Furthermore, higher OME exposure was associated with stepwise higher risks.Conclusion: Preoperative opioid use was an independent risk factor for severe complications, as well as prolonged lengths of stay, readmission, and reoperation after primary bariatric surgery.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

Gastric bypass

Sleeve gastrectomy

Bariatric surgery

Opioid

Chronic pain

Oral morphine equivalents

Complication

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)