Trends in Prescriptions for Pain Medication After Bariatric Surgery

After bariatric surgery, opioid prescriptions increased while some nonopioid pain medications decreased. These findings were published in Surgical Endoscopy.

Adults (N=3535) who underwent bariatric surgery in Utah between 2013 and 2015 were identified through the Utah Bariatric Surgery Registry. Linked data from the Utah All Payers Claims Database were evaluated for pre- and postsurgical pain medication prescriptions.

Patients were prescribed no new postsurgical pain medication (n=696) or any new postsurgical pain medication (n=643). The no medication and new medication cohorts were aged mean 44.14 (standard deviation [SD], 12.00) and 46.17 (SD, 12.62) years (P <.01), 71% and 75% were women, presurgical BMI was 46.44 (SD, 8.75) and 47.23 (SD, 8.74) kg/m², 76% and 78% were White, 51% and 52% underwent Roux-en-Y gastric bypass (RYGB), and comorbidity score index was 0.68 (SD, 1.39) and 1.00 (SD, 1.75; P <.01), respectively.

After surgery, 71% of patients were prescribed opioids, 55% nonsteroidal anti-inflammatory drugs (NSAIDs), 32% corticosteroids, and 24% muscle relaxants.

Compared with the year before surgery, in the year after surgery no change to any pain medications (P =.42), muscle relaxants (P =.22), or the number of different types of pain medications (P =.76) were observed.

After surgery, fewer patients were prescribed corticosteroids (12.17% vs 15.38%; P =.02) or NSAIDs (13.22% vs 26.44%; P <.01) but more were prescribed opioids (38.91% vs 34.13%; P =.01).

Similarly, both the number of prescriptions (P <.01) and the day supply (P <.01) of NSAIDs decreased after surgery while the number of prescriptions (P <.01) and day supply (P =.01) of opioids increased postsurgery.

More patients received postsurgical opioids who received ≥3 pain medications (odds ratio [OR], 9.49; 95% CI, 5.81-15.51; P ≤.05), 2 (OR, 4.74; 95% CI, 3.33-6.75; P ≤.05), or 1 (OR, 2.71; 1.98-3.69; P ≤.05) presurgical pain medications, presurgical benzodiazepines (OR, 3.06; 95% CI, 2.28-4.12; P ≤.05), or underwent duodenal switch compared with RYGB (OR, 1.68; 95% CI, 1.10-2.57; P ≤.05). Patients who were of Urban ethnicity were less likely to receive opioids (OR, 0.68; 95% CI, 0.47-1.00; P ≤.05).

The major limitation of this study was the lack of a nonbariatric postsurgical comparator cohort.

This study found that overall, patients who underwent bariatric surgery did not receive differing amounts of pain medication prescriptions following surgery, but that prescriptions for opioids increased and NSAIDs decreased. Additional study is needed to evaluate opioid trends in the bariatric surgery setting.

Reference

Kim J, Waitzman N, Richards N, Adams T. Prescriptions for pain medication before and after bariatric surgery. Surg Endosc. 2022;36(7):4960-4968. doi:10.1007/s00464-021-08852-w