Postoperative Opioid Use After Bariatric Surgery and Associated Factors: A Retrospective Comparison of Laparoscopic and Robotic Approaches

Background/Objectives: The opioid epidemic has increased awareness of inpatient opioid use after surgery. Effective pain control is essential for recovery; however, factors influencing postoperative opioid requirements (PORs) remain unclear. This study examined patient-specific factors and surgical platforms associated with postoperative rescue opioid use within 48 h of bariatric surgery. Methods: A retrospective chart review was conducted on patients undergoing bariatric surgery (Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG)) from March 2021 to March 2023 at a community hospital setting. Data included demographics, comorbidities, psychiatric history, prior surgeries (cholecystectomy, hernia repair, other bariatric surgery), intraoperative parameters, postoperative disposition, hospital length of stay, and PORs measured in morphine milligram equivalents (MME). Robotic and laparoscopic surgery were compared and risk factors for increased PORs were analyzed. Results: Among 442 patients (86.7% women, mean age 42.1 ± 12.0 years), robotic procedures (51.6%) had higher PORs than laparoscopic procedures (13.3 ± 13.2 versus 10.1 ± 11.2 MME; p < 0.01), mainly driven by the SG group (14.8 ± 13.3 versus 9.2 ± 9.6 MME, respectively; p < 0.01). In multivariable logistic regression, robotic surgery (OR 1.38, 95% CI: 1.02–1.88, p = 0.041), psychiatric history (OR 1.67, 95% CI: 1.11–2.51, p = 0.014), and prior surgery (OR 1.52, 95% CI: 1.03–2.24, p = 0.034) were associated with increased PORs (>10 MME). No significant differences were observed based on sex, type of procedure (SG vs. RYGB), or body mass index. Conclusions: In this study, robotic surgery was associated with higher PORs. Preoperative psychiatric evaluation and multimodal pain management strategies may assist in the optimization of analgesia in patients with psychiatric conditions or prior surgery.