Cargando…

Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control

BACKGROUND: Surgical pain management is a critical component in the success of bariatric procedures. With the opioid epidemic, there have been increased efforts to decrease opioid use. In 2019, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program developed the BSTOP prot...

Descripción completa

Detalles Bibliográficos
Autores principales: Seu, Rie, Pereira, Xavier, Goriacko, Pavel, Yaghdjian, Vicken, Appiah, Daniel, Moran-Atkin, Erin, Camacho, Diego, Kim, Jinu, Choi, Jenny
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514885/
https://www.ncbi.nlm.nih.gov/pubmed/36167874
http://dx.doi.org/10.1007/s00464-022-09646-4
_version_ 1784798368339329024
author Seu, Rie
Pereira, Xavier
Goriacko, Pavel
Yaghdjian, Vicken
Appiah, Daniel
Moran-Atkin, Erin
Camacho, Diego
Kim, Jinu
Choi, Jenny
author_facet Seu, Rie
Pereira, Xavier
Goriacko, Pavel
Yaghdjian, Vicken
Appiah, Daniel
Moran-Atkin, Erin
Camacho, Diego
Kim, Jinu
Choi, Jenny
author_sort Seu, Rie
collection PubMed
description BACKGROUND: Surgical pain management is a critical component in the success of bariatric procedures. With the opioid epidemic, there have been increased efforts to decrease opioid use. In 2019, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program developed the BSTOP protocol, a multimodal perioperative pain management regimen to minimize opioid use. The objective of this study is to evaluate the effectiveness of the BSTOP protocol on patients’ need for opioid medications during their perioperative care. METHODS: This is a single-institution prospective cohort study on patients who underwent bariatric surgery from 10/2019 to 5/2021. Data was collected on morphine equivalent dose of opioids during different stages of inpatient and outpatient care. BSTOP was implemented on 7/2020. Primary outcomes were total inpatient and outpatient opioid use as well as hospital length of hospital stay (LOS). Gabapentin was removed from the protocol between 10/20/2020 and 12/31/2020 due to side effects; it was re-implemented on 1/1/2021 due to observed spikes in opioid use during its absence. RESULTS: 1264 patients who had bariatric surgery between 10/2019 and 5/2021 were included in the study, with 409 patients before (pre-BSTOP) and 855 patients after BSTOP implementation. There was a 36% reduction in total inpatient opiate use and a 57% reduction in total outpatient opiate use. LOS also significantly decreased, from 1.53 to 1.28 days. 179 patients received BSTOP without gabapentin. These patients used more opioids in the post-anesthesia care unit and on the inpatient floors compared to pre-BSTOP and BSTOP with gabapentin patients. With total inpatient and outpatient opioid use, patients on BSTOP without gabapentin used fewer opioids than those pre-BSTOP. However, those on BSTOP without gabapentin used more opioids than those with gabapentin. CONCLUSION: The BSTOP protocol significantly reduced inpatient and outpatient opioid use as well as LOS. Gabapentin is a crucial component of the BSTOP protocol. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09646-4.
format Online
Article
Text
id pubmed-9514885
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer US
record_format MEDLINE/PubMed
spelling pubmed-95148852022-09-28 Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control Seu, Rie Pereira, Xavier Goriacko, Pavel Yaghdjian, Vicken Appiah, Daniel Moran-Atkin, Erin Camacho, Diego Kim, Jinu Choi, Jenny Surg Endosc 2022 SAGES Oral BACKGROUND: Surgical pain management is a critical component in the success of bariatric procedures. With the opioid epidemic, there have been increased efforts to decrease opioid use. In 2019, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program developed the BSTOP protocol, a multimodal perioperative pain management regimen to minimize opioid use. The objective of this study is to evaluate the effectiveness of the BSTOP protocol on patients’ need for opioid medications during their perioperative care. METHODS: This is a single-institution prospective cohort study on patients who underwent bariatric surgery from 10/2019 to 5/2021. Data was collected on morphine equivalent dose of opioids during different stages of inpatient and outpatient care. BSTOP was implemented on 7/2020. Primary outcomes were total inpatient and outpatient opioid use as well as hospital length of hospital stay (LOS). Gabapentin was removed from the protocol between 10/20/2020 and 12/31/2020 due to side effects; it was re-implemented on 1/1/2021 due to observed spikes in opioid use during its absence. RESULTS: 1264 patients who had bariatric surgery between 10/2019 and 5/2021 were included in the study, with 409 patients before (pre-BSTOP) and 855 patients after BSTOP implementation. There was a 36% reduction in total inpatient opiate use and a 57% reduction in total outpatient opiate use. LOS also significantly decreased, from 1.53 to 1.28 days. 179 patients received BSTOP without gabapentin. These patients used more opioids in the post-anesthesia care unit and on the inpatient floors compared to pre-BSTOP and BSTOP with gabapentin patients. With total inpatient and outpatient opioid use, patients on BSTOP without gabapentin used fewer opioids than those pre-BSTOP. However, those on BSTOP without gabapentin used more opioids than those with gabapentin. CONCLUSION: The BSTOP protocol significantly reduced inpatient and outpatient opioid use as well as LOS. Gabapentin is a crucial component of the BSTOP protocol. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09646-4. Springer US 2022-09-27 2023 /pmc/articles/PMC9514885/ /pubmed/36167874 http://dx.doi.org/10.1007/s00464-022-09646-4 Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle 2022 SAGES Oral
Seu, Rie
Pereira, Xavier
Goriacko, Pavel
Yaghdjian, Vicken
Appiah, Daniel
Moran-Atkin, Erin
Camacho, Diego
Kim, Jinu
Choi, Jenny
Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control
title Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control
title_full Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control
title_fullStr Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control
title_full_unstemmed Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control
title_short Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control
title_sort effectiveness of bariatric surgery targeting opioid prescriptions (bstop) protocol on postoperative pain control
topic 2022 SAGES Oral
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514885/
https://www.ncbi.nlm.nih.gov/pubmed/36167874
http://dx.doi.org/10.1007/s00464-022-09646-4
work_keys_str_mv AT seurie effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT pereiraxavier effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT goriackopavel effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT yaghdjianvicken effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT appiahdaniel effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT moranatkinerin effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT camachodiego effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT kimjinu effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol
AT choijenny effectivenessofbariatricsurgerytargetingopioidprescriptionsbstopprotocolonpostoperativepaincontrol