Opioid prescription and consumption after hospital discharge following laparoscopic bariatric surgery: a prospective cohort study
Bibliographic record
Abstract
Introduction: In the current opioid crisis, bariatric surgical patients are at increased risk of harms related to postoperative opioid overprescribing.This study aimed to assess the extent to which opioids prescribed at discharge after bariatric surgery are consumed by patients.Methods: This multicenter prospective cohort study included adult patients (≥18yo) undergoing laparoscopic bariatric surgery.Preoperative assessments included demographics and patientreported measures.Information regarding surgical and perioperative care interventions (including discharge prescriptions) was obtained from medical records.Self-reported opioid consumption was assessed weekly up to 30 days post-discharge.Number of opioid pills prescribed and consumed was compared using Wilcoxon signed-rank test.Zero-inflated negative binomial regression was used to identify predictors of post-discharge opioid consumption.Results: We analyzed 351 patients (mean age 44±11 years, BMI 45±8.0 kg/m 2 , 77% female, 71% sleeve gastrectomy, length of stay 1.6±0.6 days).The quantity of opioids prescribed at discharge (median 15 pills [IQR 15-16], 112.5 morphine milligram equivalents (MMEs) [IQR 80-112.5])was significantly higher than patient-reported consumption (median 1 pill [IQR 0-5], 7.5 MMEs [IQR 0-37.5])(p<0.001).Overall, 37% of patients did not take any opioids postdischarge and 78.5% of the opioid pills prescribed were unused.Increased post-discharge opioid consumption was associated with male sex (IRR 1.54 [95%CI 1.14 to 2.07]), higher BMI (1.03 [95%CI 1.01 to 1.05]), preoperative opioid use (1.48 [95%CI 1.04 to 2.10]), current smoking (2.32 [95%CI 1.44 to 3.72]), higher PROMIS-29 depression score (1.03 [95% CI 1.01 to 1.04]), anastomotic procedures (1.33 [95%CI 1.01 to 1.75]), and number of pills prescribed (1.04 [95%CI 1.01 to 1.06]).Conclusion: This study supports that most opioid pills prescribed to bariatric surgery patients at discharge are not consumed.Patient and procedure-related factors may predict opioid consumption.Individualized post-discharge analgesia strategies with minimal or no opioids may be feasible and should be further investigated in future research.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".