Background

Perioperative pain control has been a rate-limiting step for discharge. Postoperative opioids increase nausea and reduce compliance with early ambulation in enhanced recovery pathways. Low opioid enhanced recovery pathways may enable same day discharge and reduce post-operative opioid use. This study looks at a unique time point: same day discharges during the COVID epidemic. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) introduced the Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) quality improvement collaborative to provide bariatric centers with guidance to reduce opioid use through patient education, multimodal pain control strategies, use of regional anesthesia, to minimize perioperative opioid use. Our center participated in BSTOP, collecting data on post-operative opioid use through examination of medication administration records, and patients' at-home opioid use. During the COVID pandemic, due to bed shortages, we began providing outpatient bariatric surgery. One barrier to the move to routine outpatient bariatric surgery is fear that pain will not be adequately controlled at home, which will lead to decreased ambulation, increasing risk for post-operative complications. In our sample of 94 patients (47 inpatient, 47 outpatient), inpatients used significantly more opioids (measured as milligram of morphine equivalents, or MME) than outpatients, with a median of 39.5 MME, compared to 27 MME (p=0.016). The idea that bariatric surgery recovery is too painful to allow for same day discharge is false and outpatient bariatric surgery results in less perioperative opioid exposure. If we want patients exposed to less opioids, we should get them out of the hospital sooner.