Table 2.
Associations with Continuation and Initiation of Prescribed Opioid Analgesic Use, following Bariatric Surgery.
| Regular Opioid Use Post-Surgery
|
||||
|---|---|---|---|---|
| Continueda (N=280) | Initiatedb (N=1631) | |||
| ARR(95%CI)c | P | ARR(95%CI)c | P | |
| Pre-surgery | ||||
| Male (Ref. = Female) | 1.07(0.91–1.27) | 0.40 | 0.91(0.74–1.12) | 0.36 |
| Age, per 10 years younger | 1.04(0.97–1.11) | 0.32 | 1.00(0.92–1.08) | 0.93 |
| Race (Ref. = Black) | 0.20 | 0.40 | ||
| White | 0.91(0.73–1.13) | 1.32(0.88–1.98) | ||
| Other | 1.11(0.80–1.52) | 1.29(0.72–2.29) | ||
| Hispanic ethnicity | 1.02(0.71–1.47) | 0.92 | 0.86(0.49–1.51) | 0.60 |
| Household income <$25,000 (Ref. = ≥$25,000) | 1.00(0.85–1.18) | 0.99 | 1.04(0.85–1.28) | 0.69 |
| Insurance (Ref. = Private) | 0.60 | <0.01 | ||
| Public | 1.03(0.88–1.21) | 1.33(1.09–1.64) | ||
| Other/unknown/none | 0.91(0.71–1.16) | 1.46(1.15–1.84) | ||
| SF-36 Bodily pain, per 10 points lower (worse) | 1.14(1.03–1.25) | 0.01 | 1.55(1.38–1.74) | <.001 |
| SF-36 Mental component score, per 10 points lower (worse) | d | 0.94(0.86–1.02) | 0.14 | |
| Smoke cigarettes (Ref. = No) | 1.05(0.87–1.26) | 0.61 | 1.25(0.99–1.59) | 0.06 |
| Surgical procedure (Ref. = Laparoscopic RYGB) | 0.93 | 0.70 | ||
| Open RYGB | 0.98(0.80–1.21) | 1.02(0.81–1.29) | ||
| LAGB | 0.99(0.83–1.18) | 0.87(0.66–1.15) | ||
| Other | 0.91(0.67–1.22) | 0.88(0.61–1.28) | ||
| Post-surgery | ||||
| History of back, hip, knee or ankle surgery | 1.01(0.89–1.14) | 0.91 | 1.21(1.02–1.45) | 0.03 |
| Revision, reversal or new bariatric procedure | 1.09(0.85–1.40) | 0.48 | 1.50(1.08–2.07) | 0.01 |
| Pre- to post-surgery change | ||||
| Weight change, per −5% (loss) | 1.00(0.98–1.02) | .84 | 1.03(0.99–1.07) | 0.12 |
| SF-36 Bodily pain, per 10 points lower (worse) | 1.11(1.04–1.18) | <.01 | 1.72(1.57–1.90) | <.001 |
| SF-36 Mental component score, per 10 points lower (worse) | d | 0.91(0.85–0.97) | <0.01 | |
| Pre- and post-surgery status | ||||
| Prescribed benzodiazepine use | 0.02 | 0.24 | ||
| Started vs. never | 0.90(0.75–1.07) | 1.26(1.00–1.57) | ||
| Continued vs. stopped | 1.21(1.02–1.44) | 1.05(0.64–1.74) | ||
| Continued vs. never | 1.15(1.01–1.30) | 1.15(0.82–1.61) | ||
| Prescribed non-opioid analgesic usee | <.001 | <.001 | ||
| Started vs. never | 2.06(1.59–2.68) | 6.09(4.77–7.78) | ||
| Continued vs. stopped | 2.44(1.99–2.98) | 4.00(2.60–6.16) | ||
| Continued vs. never | 2.14(1.68–2.72) | 4.05(2.98–5.49) | ||
Abbreviations: LAGB, laparoscopic adjustable gastric banding; SF-36, Short-Form 36-item Health Survey;
RYGB, Roux-en-Y gastric bypass.
Regular use of prescribed opioids pre- and post-surgery vs. regular use pre-surgery only.
Regular use of prescribed opioids post-surgery only vs. no regular use pre- and post-surgery.
Adjusted for other variables as indicated in this table, as well as site.
The ARR (95%CI) is not reported for variables that were not retained in the model due to lack of significance (P>.05 overall).
When prescribed non-steroidal anti-inflammatory drug (NSAID) use replaced prescribed non-opioid analgesic use, NSAID use was not significantly associated with risk of continued opioid use (P=0.69; started vs. never ARR=1.03, 95%CI, 0.88–1.20; continued vs. stopped ARR=1.09, 95%CI, 0.91–1.31; continued vs. never ARR=1.12, 95%CI, 0.91–1.37). However, compared to not using NSAIDs pre- and post-surgery, starting (ARR 1.63, 95%CI, 1.29–2.06) or continuing (ARR 1.51, 95%CI, 1.04–2.19) NSAID use were associated with increased risk of post-surgery initiated opioid use (P<.001). The risk of post-surgery initiated opioid use did not significantly differ by continued vs. stopped NSAID use (ARR=1.29, 95%CI, 0.86–1.94).