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Factors that influence discharge opioid prescribing among bariatric surgeons across Michigan

      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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