Highlights
- •New persistent opioid use (NPOU) is a common post-operative complication for patients undergoing bariatric surgery.
- •Despite the link between post-operative opioid prescriptions and NPOU, opioids remain the cornerstone of pain management.
- •Interventions that address this variation are often focused on awareness of guidelines, however, the reasons are complex.
- •Factors that influence opioid prescription practices exist at the patient, provider, institution, and collaborative levels.
- •Understanding determinants that impact stakeholder alignment is critical to improving adherence to guideline-concordant care.
Abstract
Background
Opioid prescribing following bariatric surgery has been a focus due to its association
with new persistent opioid use (NPOU) and worse outcomes. Guidelines have led to a
reduction in opioids prescribed, but there remains variation in prescribing practices.
Methods
We conducted interviews with 20 bariatric surgeons across Michigan. Transcripts were
analyzed using descriptive content analysis.
Results
At the patient level, surgeons described the role of surgical history and pain tolerance. At the
provider level, surgeons discussed patient dissatisfaction, reputation, and workload. At the
institution level, surgeons discussed colleagues, resources, and administration. At a collaborative level, surgeons described the role of evidence and performance measures. There was
lack of consensus on whether NPOU is a problem facing patients undergoing bariatric
surgery.
Conclusion
Despite efforts aimed at addressing opioid prescribing, variability exists in prescribing
practices. Understanding determinants that impact stakeholder alignment is critical
to increasing adherence to guideline-concordant care.
Keywords
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Article info
Publication history
Published online: July 31, 2022
Accepted:
July 24,
2022
Received in revised form:
July 20,
2022
Received:
June 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
