Opioids caused 70% of the 71,000 drug-overdose deaths in the US in 2019, a problem magnified by the COVID pandemic. About 6% of opioid-naïve general surgery patients and 14% of bariatric patients become chronic opioid users after surgery. The purpose of this MBSAQIP quality improvement project was to provide centers with a toolkit to reduce opioid use after bariatric surgery.
The project proposal was approved in May 2019 by ACS. All accredited MBSAQIP centers were invited to participate. The timeline included 3 phases for data collection in 17 custom fields; Baseline, Pilot, and Implementation scheduled to close March 2021. Implementation phase data has been audited through September 2020.
Initially, 324 centers agreed to participate; 310 centers are actively collecting data totaling 37,891 cases. Preoperative opioid use was reported in 7.14% (n=2708) which disqualified patients from analysis. 80% of centers completed >75% of data fields. 8/9 binary measures improved from the baseline audit. Compared to baseline, morphine milliequivalent use (MME) decreased for all phases of care: inpatient 68.2 to 44.2 MME, prescribed at discharge 129.5 to 111.9 MME, used post-discharge 60.3 to 49.3 MME. 1194 patients returned unused opioids for safe disposal (7.3%).
Despite COVID, participation rates in BSTOP have remained high with significant improvements in 8/9 binary fields including increased non-opioid analgesic and TAP block use. Decreases were observed in opioid prescribing as well as MME use in all phases of care. Excessive discharge opioid prescribing remains a key target for improvement prior to project conclusion.