Liposomal bupivacaine for sleeve gastrectomy is associated with improved opioid outcomes and lower odds of opioid use disorder: claims-based analysis

BACKGROUND: Patients undergoing bariatric surgery may be at increased risk for postsurgical opioid dependence, highlighting a need for opioid-sparing anesthesia. OBJECTIVES: Liposomal bupivacaine (LB), a prolonged release formulation of bupivacaine, may improve postoperative pain management and reduce postsurgical opioid use. This retrospective claims-database study investigated the effects of LB versus non-LB analgesia on opioid use and healthcare resource utilization (HCRU) in patients receiving laparoscopic sleeve gastrectomy (SG). SETTING: Retrospective study using the IQVIA linkage claims database. METHODS: Data from patients aged ≥18 years and free of opioid prescriptions within the prior 6 months undergoing inpatient laparoscopic SG between January 1, 2016, and December 31, 2019, were analyzed. Outcomes included perioperative opioid use in oral morphine milligram equivalents (MMEs), opioid-related adverse events (ORAEs), postdischarge HCRU, continued (>2 weeks to 3 months postdischarge) and persistent (4-6 months postdischarge) opioid use, and opioid use disorder (OUD) at 6 months. RESULTS: Of 4298 patients (2149 in each cohort), LB was associated with significantly fewer perioperative opioids (100.53 versus 155.48 MMEs; mean difference, -54.95 [95% confidence interval (CI), -64.46, -45.45]; P < .0001), lower rates of in-hospital ORAEs (9.63% versus 13.82%; odds ratio [OR], .67 [95% CI, .55, .80]; P < .0001), significantly lower incidence of OUD (.09% versus .51%; OR, .18 [95% CI, .04, .82]; P = .026), shorter hospital length of stay (P = .0008), and significantly lower odds of 30-day postdischarge hospital readmissions (P = .025) versus non-LB analgesia. CONCLUSIONS: LB reduced opioid use, in-hospital ORAEs, OUD, and hospital readmissions after laparoscopic SG.