Over the last two decades, the opioid crisis in America and on Long Island has wreaked havoc on thousands of families and individuals. Here on the South Shore, doctors at South Shore University Hospital have implemented a program that eliminates the need for bariatric patients to go home with prescription opioids and shortens their recovery. The program is expanding to other areas of the hospital with hernia and gallbladder surgeries able to utilize the technique. The surgeons and anesthesiologists use a long-lasting anesthetic that lines the abdomen during surgery, eliminating the need for post-op opioids.
In March of 2021, Jonathan Akinrele, 23, of Amityville, had a gastric sleeve procedure done. According to his surgeon, Dr. David Miller Pechman, the procedure involves stapling and removing 80 percent of the lateral edge of the stomach. Patients are left with a stomach that’s banana or sleeve shaped. The new shape of the stomach causes the patient to get fuller quicker and for longer. Additionally, hormonal changes happen after the surgery that make patients feel full and increase the patients’ metabolism, which allows the patient to better stick to their diet plan and lose weight. Akinrele did not receive postoperative opioids and has lost over 100 pounds. He noted that after the surgery, his pain was not bad and not something he was heavily focused on.
During his time at a fellowship at another hospital, Dr. Pechman said that they gave every patient opioids and was expecting patients to at least be skeptical about not receiving them after their procedures at South Shore. But, he noted that the opioid crisis is in the public consciousness now, so patients are either thrilled that they’re not going home with the drugs or ambivalent. There is also a closed Facebook group available for patients to join to chat with other patients who have gone through the process.
“I haven’t sent a patient home on opioids in three years,” Dr. Pechman noted.
Dr. Dominick Gadaleta, the chief of surgery at South Shore University Hospital, said that the program has been especially impactful with cancer patients because they recover from procedures quicker and are then able to start their other treatment plans sooner. Dr. Gadaleta also noted the importance of removing opioids from the community.
“Historically, what has happened is that doctors send their patients home with 30 or 60 oxycodone pills or hydrocodone pills for pain after the surgery,” Dr. Gadaleta said. “And most patients after the surgery only have pain that requires opioids for a few days at most, so now they’ve got 20 unused tablets sitting in their medicine cabinet for their kids to get into or to end up out in the community.”
Dr. Andrew Bates, a bariatric surgeon at South Shore University Hospital, noted that in the last 10 to 15 years he has really seen a change in doctors’ attitudes towards opioids and their effect on patients and the community.
“After surgery, patients would be given upwards of 40 to 60 pills to go home with, and I remember hearing very explicitly from attendings, ‘I don’t want to be called,’” Dr. Bates said. “And that was the mentality: keep the patients happy with these medications. That was the old guard.”
Today, patients recover quicker, with less pain and without the need for opioids.
“If we eliminate the need for them, we eliminate a whole bunch of side effects,” Dr. Pechman said. “A lot of patients that wind up getting addicted, it’s through no fault of their own. It’s that they all of a sudden were treating an addiction that they didn’t need to get.”
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