Background

Bariatric Surgery Targeting Opioid Prescribing (BSTOP) is an initiative to reduce post-operative opioid use. We investigated whether a BSTOP protocol could significantly decrease morphine milligram equivalents (MME) without negatively impacting pain scores.

Methods

This is a single institution, multi-center retrospective study of patients undergoing primary bariatric surgery from January 2017 to December 2022. BSTOP was implemented January 1, 2020 (BSTOP group). Prior to BSTOP there was no standardized analgesia regimen regarding opioid restriction; PCA and oral narcotics post discharge were routine(Non-BSTOP). Primary outcomes were MME and pain scores (Numerical Rating System). Comparisons were made between groups using Student's t-test with p-value <0.05 considered significant.

Results

There were 3,263 patients in the study group. There were 1560 patients in the Non-BSTOP Group ( 907 RYGB and 653 sleeve). The 1703 patients in the BSTOP group (1,207 RYGB and 496 sleeve) demonstrated an 86.3% reduction in inpatient MME (182.81 vs 25.03, p<0.0001) and 91.1% reduction in outpatient MME (213.79 vs 19.02, p<0.0001). Inpatient self-reported pain was similar between groups (5.14 vs 5.14, p=0.98).

Conclusions

The BSTOP initiative is effective in reducing opioid use both inpatient and outpatient without increasing pain scores. Further investigation is needed to refine multimodality pain control to further reduce pain scores.