New persistent opioid use after bariatric surgery: a systematic review and pooled proportion meta-analysis

Verhoeff, Kevin

doi:10.1007/s00464-022-09291-x

Cited by 13 publications

(10 citation statements)

References 29 publications

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“… 24 , 34 , 36 – 51 Of these, five were systematic reviews (with three meta-analyses) assessing chronic pain in patients who had undergone a surgical procedure, 34 , 36 – 39 and 13 were systematic reviews (with nine meta-analyses) assessing persistent opioid use after surgery. 24 , 40 – 51 …”

Section: Resultsmentioning

confidence: 99%

“…This umbrella review included 18 systematic reviews published between 2009 and 2022. 24,34,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] Of these, five were systematic reviews (with three meta-analyses) assessing chronic pain in patients who had undergone a surgical procedure, 34,[36][37][38][39] and 13 were systematic reviews (with nine meta-analyses) assessing persistent opioid use after surgery. 24,[40][41][42][43][44][45][46][47][48][49][50][51]…”

Section: Selection Of Studiesmentioning

confidence: 99%

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Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Bansal,

Ang,

Chen

2023

British Journal of Pain

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Background Chronic post-surgical pain (CPSP) and persistent post-operative opioid use (PPOU) are inconsistently defined in published literature. This review comprehensively summarised their definitions, prevalence and determinants from existing systematic reviews or meta-analyses. Methods Systematic reviews or meta-analyses evaluating the prevalence of CPSP and PPOU in adults after surgeries were retrieved from an electronic database search applying structured search strategies in PubMed, MEDLINE, Embase, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to 31 December 2022. Two reviewers selected systematic reviews, extracted data regarding the definition, prevalence and risk factors of CPSP and PPOU and assessed the quality using the AMSTAR 2 tool. Results The study identified 6936 records related to chronic pain and persistent opioid use in patients after surgery, of which 24 articles were identified for full-text review. Eighteen systematic reviews were included in this umbrella review, of which five systematic reviews assessed chronic pain in patients who had undergone a surgical procedure, and 13 reviews assessed persistent opioid use after surgery. Despite considerable variations in patient characteristics (from age ≥18 years), types of surgeries, follow-up duration and the definitions of measures, most reviews were of medium to good quality (fulfilled 9-11/16 AMSTAR 2 criteria). The prevalence of CPSP and PPOU, commonly synthesised at 3, 6 or 12 months after surgeries, varied from 5%–58% and 2%–65%, respectively, despite various terminologies, definitions and timing of measures and associated determinants. The prevalence of neuropathic pain in CPSP was obtainable for four surgeries, with 9%–74%. Conclusion To inform future practice and policy to optimise pain management and opioid safety, consensus on standardising measurements and further studies assessing risk factors associated with CPSP, PPOU and adverse outcomes are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Selection Of Studiesmentioning

confidence: 99%

Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Bansal,

Ang,

Chen

2023

British Journal of Pain

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“…In the past decade, more studies have assessed the potential for non-operative adverse outcomes following MBS, including the risk of substance and alcohol use disorders and suicide or accidental deaths 73. Overall, 18 observational studies with sample sizes ranging from 50 patients to >4000 patients, indicate that MBS is associated with an increased risk of alcohol and substance use disorders compared with usual care 7475. A meta-analysis of five observational studies at three years after surgery found that the pooled odds of alcohol use disorder were 1.83 (1.53 to 2.18; P<0.001) for RYGB compared with non-surgical treatment.…”

Section: Risks Of Metabolic/bariatric Surgerymentioning

confidence: 99%

Long term outcomes of metabolic/bariatric surgery in adults

Courcoulas,

Daigle,

Arterburn

2023

BMJ

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The prevalence of obesity continues to rise around the world, driving up the need for effective and durable treatments. The field of metabolic/bariatric surgery has grown rapidly in the past 25 years, with observational studies and randomized controlled trials investigating a broad range of long term outcomes. Metabolic/bariatric surgery results in durable and significant weight loss and improvements in comorbid conditions, including type 2 diabetes. Observational studies show that metabolic/bariatric surgery is associated with a lower incidence of cardiovascular events, cancer, and death. Weight regain is a risk in a fraction of patients, and an association exists between metabolic/bariatric surgery and an increased risk of developing substance and alcohol use disorders, suicidal ideation/attempts, and accidental death. Patients need lifelong follow-up to help to reduce the risk of these complications and other nutritional deficiencies. Different surgical procedures have important differences in risks and benefits, and a clear need exists for more long term research about less invasive and emerging procedures. Recent guidelines for the treatment of obesity and metabolic conditions have been updated to reflect this growth in knowledge, with an expansion of eligibility criteria, particularly people with type 2 diabetes and a body mass index between 30.0 and 34.9.

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“…Both new and prolonged opioid use are important complications of bariatric surgical procedures [ 17 ]. Patients with obesity using prescription opioids preoperatively are more likely to continue these drugs after bariatric surgery than opioid-naïve patients, which is not without risks [ 18 , 19 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with obesity using prescription opioids preoperatively are more likely to continue these drugs after bariatric surgery than opioid-naïve patients, which is not without risks [ 18 , 19 , 20 , 21 , 22 ]. The perioperative use of opioids in bariatric surgery results in worsened clinical outcomes (e.g., a more extended hospital stay and increased episodes of apnea) and in particular persistent opioid use post-discharge [ 17 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

Wuyts

Torensma

Schellekens

et al. 2023

JCM

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The persisting use of opioids following bariatric surgery has emerged as a prevalent complication, heightening the probability of opioid-related harm (ORM), such as opioid-related fatalities and prescription opioid use disorder (OUD). A comprehensive review of PubMed literature from 1990 to 2023 was conducted to pinpoint physiological influences on postoperative ORM. As a result, we found that patients undertaking bariatric operations often exhibit an inherently higher risk for substance use disorders, likely attributable to genetic predisposition and related neurobiological changes that engender obesity and addiction-like tendencies. Furthermore, chronic pain is a common post-bariatric surgery complaint, and the surgical type impacts opioid needs, with increased long-term opioid use after surgeries. Additionally, the subjective nature of pain perception in patients with obesity can distort pain reporting and the corresponding opioid prescription both before and after surgery. Furthermore, the postoperative alterations to the gastrointestinal structure can affect the microbiome and opioid absorption rates, resulting in fluctuating systemic exposure to orally ingested opioids. The prospect of ORM development post-bariatric surgery appears amplified due to a preexisting susceptibility to addictive habits, surgically induced pain, modified gut–brain interaction and pain management and the changed pharmacokinetics post-surgery. Further research is warranted to clarify these potential risk variables for ORM, specifically OUD, in the bariatric population.

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New persistent opioid use after bariatric surgery: a systematic review and pooled proportion meta-analysis

Cited by 13 publications

References 29 publications

Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Long term outcomes of metabolic/bariatric surgery in adults

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

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