Background

Short-term opioid analgesics are often prescribed to manage acute pain following bariatric surgery. In some cases, opioid use may persist beyond the acute pain phase and may develop into chronic prescription opioid use (CPOU) in opioid-naïve patients. Our objective was to compare initiation and persistence of CPOU in a large multi-site cohort of veterans who underwent bariatric surgery (open Roux-en-Y gastric bypass (ORYGB), laparoscopic RYGB (LRYGB), or laparoscopic sleeve gastrectomy (LSG)) compared to non-surgical matches.

Methods

: In a retrospective cohort study, we identified 3,939 veterans who underwent ORYGB, LRYGB or LSG in Veterans Administration (VA) bariatric centers from 2001-2016. Using sequential stratification, we matched 2,822 surgical patients without CPOU at baseline to 26,392 non-surgical controls and 1,117 surgical patients with baseline CPOU to 9,531 non-surgical controls. CPOU incidence in Veterans without baseline CPOU was estimated by procedure type in Cox regression models; continuation of CPOU was estimated using generalized estimating equations (GEEs) in Veterans with baseline CPOU.

Results

In bariatric surgery patients with baseline CPOU, post-surgical CPOU declined over time. Matched non-surgical controls with baseline CPOU also experienced a decrease in CPOU during the study interval. In patients without baseline CPOU, bariatric patients were more likely to initiate CPOU than matched non-surgical controls following ORYGB (hazard ratio (HR)=1.22, 95% confidence interval (CI): 1.06-1.41) or LRYGB (hazard ratio (HR)=1.19; 95% confidence interval (CI), 1.06-1.34). Similarly, patients undergoing LSG had higher CPOU incidence 1-to-5 years following surgery (HR=1.28; 95% CI, 1.05-1.56) than non-surgical controls.

Conclusions

Bariatric surgery was not associated with continuation of CPOU in patients with baseline CPOU but was associated with greater risk of CPOU incidence in patients without baseline CPOU.