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Opioid prescribing following bariatric surgery has been a focus due to its association with new persistent opioid use (NPOU) and worse outcomes. Guidelines have led to a reduction in opioids prescribed, but there remains variation in prescribing practices.We conducted interviews with 20 bariatric surgeons across Michigan. Transcripts were analyzed using descriptive content analysis.At the patient level, surgeons described the role of surgical history and pain tolerance. At the provider level, surgeons discussed patient dissatisfaction, reputation, and workload. At the institution level, surgeons discussed colleagues, resources, and administration. At a collaborative level, surgeons described the role of evidence and performance measures. There was lack of consensus on whether NPOU is a problem facing patients undergoing bariatric surgery.Despite efforts aimed at addressing opioid prescribing, variability exists in prescribing practices. Understanding determinants that impact stakeholder alignment is critical to increasing adherence to guideline-concordant care.

Enhanced Recovery After Surgery (ERAS) Protocols are well-established in fields such as colorectal surgery but within bariatric surgery have not been uniformly adopted by all programs.Qualitative study with focus groups at five hospitals participating in a statewide bariatric surgery quality improvement collaborative. Members of the clinical care team at each pilot site participated. Participants described barriers to implementation, and strategies to address these.Participants expressed satisfaction with the implementation process. Barriers included a lack of buy-in from team members, availability of specific resources, staffing turnover, and interruption to implementation. Increased communication at all phases and a specific point-person to guide implementation would improve success.These findings will be integrated into our work as we continue to implement this protocol at all hospitals participating within the collaborative. Future work will focus on the impact of the protocol on clinical outcomes and patient satisfaction following surgery.