Jessica J Wyse1,2, Anders Herreid-O'Neill3, Jacob Dougherty4, Sarah Shull3, Katherine Mackey3, Kelsey C Priest5, Honora Englander6, Jessica Thoma7, Travis I Lovejoy3,8. 1. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA. Jessica.Wyse@va.gov. 2. School of Public Health, Oregon Health & Science University, Portland, OR, USA. Jessica.Wyse@va.gov. 3. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA. 4. Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA. 5. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. 6. Section of Addiction Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA. 7. Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada. 8. Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
Abstract
BACKGROUND: Medication for opioid use disorder, including buprenorphine and methadone, is considered the gold standard treatment for opioid use disorder (OUD). As the number of patients receiving buprenorphine has grown, clinicians increasingly care for patients prescribed buprenorphine who present for surgery and require management of perioperative pain. OBJECTIVE: To describe practice patterns of perioperative and post-surgical use of buprenorphine among patients prescribed buprenorphine for OUD who experience major surgery. DESIGN: Retrospective cohort study utilizing data from the VA Corporate Data Warehouse (CDW), a national repository of patient-level data. Data not accessible in CDW, including clinical instructions to patients to modify buprenorphine dose, were accessed via chart review. PARTICIPANTS: National sample of patients receiving care through the Veterans Health Administration. MAIN MEASURES: We report descriptive statistics on the incidence of buprenorphine dose hold prior to, during, and immediately following surgery, as well as post-surgical outcomes. Multivariable logistic regression identified socio-demographic and clinical characteristics associated with perioperative hold. KEY RESULTS: Our final sample comprised 183 patients, the majority of whom were white and male. Most patients (66%) experienced a perioperative buprenorphine dose hold: during the pre-operative, day of surgery, and post-operative periods, 40%, 62%, and 55% of patients had buprenorphine held. Buprenorphine dose hold was less likely for patients who had experienced homelessness/housing insecurity in the year prior to surgery (aOR = 0.25; 95% CI 0.10-0.61) as well as patients residing in rural areas (aOR=0.29; 0.12-0.68). Within the 12-month period following surgery, 122 patients (67%) were retained on buprenorphine, 10 patients (5.5%) had experienced an overdose, and 15 (8.2%) had died. CONCLUSIONS: We identified high rates of perioperative buprenorphine dose holds. As holding buprenorphine perioperatively does not align with emerging clinical recommendations and carries significant risks, educational campaigns or other provider-targeted interventions may be needed to ensure patients with OUD receive recommended care.
BACKGROUND: Medication for opioid use disorder, including buprenorphine and methadone, is considered the gold standard treatment for opioid use disorder (OUD). As the number of patients receiving buprenorphine has grown, clinicians increasingly care for patients prescribed buprenorphine who present for surgery and require management of perioperative pain. OBJECTIVE: To describe practice patterns of perioperative and post-surgical use of buprenorphine among patients prescribed buprenorphine for OUD who experience major surgery. DESIGN: Retrospective cohort study utilizing data from the VA Corporate Data Warehouse (CDW), a national repository of patient-level data. Data not accessible in CDW, including clinical instructions to patients to modify buprenorphine dose, were accessed via chart review. PARTICIPANTS: National sample of patients receiving care through the Veterans Health Administration. MAIN MEASURES: We report descriptive statistics on the incidence of buprenorphine dose hold prior to, during, and immediately following surgery, as well as post-surgical outcomes. Multivariable logistic regression identified socio-demographic and clinical characteristics associated with perioperative hold. KEY RESULTS: Our final sample comprised 183 patients, the majority of whom were white and male. Most patients (66%) experienced a perioperative buprenorphine dose hold: during the pre-operative, day of surgery, and post-operative periods, 40%, 62%, and 55% of patients had buprenorphine held. Buprenorphine dose hold was less likely for patients who had experienced homelessness/housing insecurity in the year prior to surgery (aOR = 0.25; 95% CI 0.10-0.61) as well as patients residing in rural areas (aOR=0.29; 0.12-0.68). Within the 12-month period following surgery, 122 patients (67%) were retained on buprenorphine, 10 patients (5.5%) had experienced an overdose, and 15 (8.2%) had died. CONCLUSIONS: We identified high rates of perioperative buprenorphine dose holds. As holding buprenorphine perioperatively does not align with emerging clinical recommendations and carries significant risks, educational campaigns or other provider-targeted interventions may be needed to ensure patients with OUD receive recommended care.
Authors: Jessica J Wyse; Adam J Gordon; Steven K Dobscha; Benjamin J Morasco; Elizabeth Tiffany; Karen Drexler; Friedhelm Sandbrink; Travis I Lovejoy Journal: Subst Abus Date: 2018 Impact factor: 3.716
Authors: T Anthony Anderson; Aurora N A Quaye; E Nalan Ward; Timothy E Wilens; Paul E Hilliard; Chad M Brummett Journal: Anesthesiology Date: 2017-06 Impact factor: 7.892
Authors: Jessica A Dreifuss; Margaret L Griffin; Katherine Frost; Garrett M Fitzmaurice; Jennifer Sharpe Potter; David A Fiellin; Jeffrey Selzer; Mary Hatch-Maillette; Susan C Sonne; Roger D Weiss Journal: Drug Alcohol Depend Date: 2013-01-18 Impact factor: 4.492
Authors: Andrea K Finlay; Alex H S Harris; Joel Rosenthal; Jessica Blue-Howells; Sean Clark; Jim McGuire; Christine Timko; Susan M Frayne; David Smelson; Elizabeth Oliva; Ingrid Binswanger Journal: Drug Alcohol Depend Date: 2016-01-24 Impact factor: 4.492