Variation in opioid-free discharge after metabolic surgery from 2018 to 2023: a state-wide analysis from the Michigan Bariatric Surgery Collaborative.

Background: Efforts have been made to reduce opioid prescribing after metabolic-bariatric surgery (MBS) given the increased risk for misuse. Variation in prevalence of opioid-free discharge following MBS and its impact on outcomes remains unclear.

Objectives: To evaluate variation in opioid prescribing practices after MBS and the impact of opioid-free discharge on outcomes.

Setting: MBS programs participating in a state-wide quality improvement collaborative.

Methods: Using a state-wide bariatric-specific data registry, all patients who underwent MBS between 2018 and 2023 and had opioid prescribing data were identified (n = 54,276). Patient characteristics and 30-day risk-adjusted outcomes were compared between patients who were and were not prescribed opioids at discharge. Surgeon and practice characteristics were also compared between the top and bottom quartiles of opioid-free discharge.

Results: The prevalence of opioid-free discharge increased from 7.7% to 32.1% over the study period. Only .4% of patients, who were opioid-free at discharge, obtained an opioid prescription within 30 days of discharge. Opioid-free discharge was associated with lower rates of emergency department (ED) visits (7.7% vs 8.2%, P = .0008), despite similar complication rates (7.6% vs 7.3%, P = .7261). There were no significant differences in age, case volume, or practice types between surgeons in the top quartile and bottom quartile for opioid-free discharge.

Conclusions: Opioid-free discharge after MBS has increased in prevalence with extremely low failure rates without negatively impacting ED visit rates. Variation in opioid prescribing persists and may be due to patient-specific factors as well as surgeon-specific preference.