Background

With the growing opioid crisis in the US, trends have turned towards finding ways to limit their unnecessary use in all aspects of medicine. Bariatric Surgery Targeting Opioids Prescriptions (BSTOP) is a MBSAQIP QI project run from October 1, 2019 to March 31, 2021 with the goal of reducing opioid use in participating MBSAQIP accredited bariatric programs.

Methods

Preoperative, perioperative, and postoperative results are broken into three phases; Data Collection, Pilot, and Implementation. The protocol included routine use of at least two non-opioids prior to anesthesia, avoidance of opioids intraoperatively with the use of TAP blocks, as well as IV induction of ketamine, lidocaine, or magnesium, routine use of at least two non-opioids postoperatively, and finally discharge on at least one non opioid for at least 3 to 5 days after surgery.

Results

At our center, median inpatient opioid use decreased from 40 MMEs to 12 (BSTOP 34 to 25). Opioid prescriptions on discharge decreased from 71.2% to 10.2% (BSTOP 81.9% to 74.1%,) with an increase in non-opioid prescriptions on discharge from 17% to 76.9% (BSTOP 24.8% to 47.3%.) TAP blocks increased from 0% to 71.4%.

Conclusions

The BSTOP program at our site appears to be an effective way to decrease opioid use in bariatric surgery patients. Participation by all members of the perioperative care team in a structured protocol is necessary for most efficient results. More studies are required to further identify the most effective intervention on further decreasing opioid use and improving bariatric surgery for patients.