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Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention
Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Sweden.ORCID iD: 0000-0003-0577-6185
Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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2023 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 3, p. e552-e560Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. SUMMARY OF

BACKGROUND DATA: Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups.

METHODS: Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention.

RESULTS: During the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98).

CONCLUSIONS: Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023. Vol. 277, no 3, p. e552-e560
Keywords [en]
bariatric surgery, gastric bypass surgery, obesity, opioids, sleeve gastrectomy, weight loss
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-103633DOI: 10.1097/SLA.0000000000005192ISI: 000928273100011PubMedID: 36700782Scopus ID: 2-s2.0-85147444164OAI: oai:DiVA.org:oru-103633DiVA, id: diva2:1731390
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and Welfare
Note

Funding agencies:

Funding Grants Office at Region Örebro County 

United States Department of Health & Human Services

National Institutes of Health (NIH) - USA

Available from: 2023-01-27 Created: 2023-01-27 Last updated: 2024-11-20Bibliographically approved
In thesis
1. Opioid use before and after bariatric surgery
Open this publication in new window or tab >>Opioid use before and after bariatric surgery
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Opioid analgesics are highly effective in acute pain, but chronic opioid use can result in serious adverse consequences. Concerns about emerging opioid use after bariatric surgery have been raised. The aim of this thesis was to find out if opioid use is increasing after bariatric surgery in Sweden. Study I included patients operated with primary gastric bypass surgery. Chronic opioid use increased from 4.6% beforeto 5.5% after surgery and daily dose from 1.9 mg to 2.5 mg. No differencein opioid use between women and men was found. In study II we increased the follow-up period to 8 years and compared biannual prevalence of opioid use and daily dose in patients going through any bariatric surgery procedure with an obese control group going through a commercial intensive lifestyle treatment. In the surgical group, opioid use prevalence and dose increased more rapidly than in the intensive lifestyle group. Surgery patients were also found to have an increased risk of dying from opioid-related causes.

In study III we investigated if socioeconomic factors are associated with new chronic opioid use after gastric bypass surgery. We found that the risk of new chronic opioid use increase if you; are second generation immigrant, receive financial aid, are unemployed or divorced/widowed. Having a higher level of education and a higher disposable income reduced the risk of chronic opioid use in the study. In study IV we examined if having an opioid prescription dispensed at discharge was associated with chronic opioid use after gastric bypassor sleeve gastrectomy. We found that 32.3% of the patients had an opioid prescription dispensed at discharge, and that this was associated with an almost doubled risk of chronic opioid use three years after surgery.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 74
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 307
Keywords
Opioid analgesics, bariatric surgery, socioeconomics
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-116589 (URN)9789175296081 (ISBN)9789175296098 (ISBN)
Public defence
2024-12-13, Örebro universitet, Campus USÖ, Tidefeltsalen, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2024-10-08 Created: 2024-10-08 Last updated: 2024-12-16Bibliographically approved

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Wallén, StefanOttosson, JohanSzabo, EvaEkbäck, Maria Palmetun

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