Perioperative Management of Buprenorphine/Naloxone in a Large, National Health Care System: a Retrospective Cohort Study.
Perioperative Management of Buprenorphine/Naloxone in a Large, National Health Care System: a Retrospective Cohort Study.
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大型国家卫生保健系统中丁丙诺啡/纳洛酮的围手术期管理：一项回顾性队列研究。
DOI：
10.1007/s11606-021-07118-4
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发表时间：
2022
影响因子：
5.7
通讯作者：
Lovejoy,TravisI
中科院分区：
文献类型：
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作者：
Wyse,JessicaJ;Herreid-O'Neill,Anders;Dougherty,Jacob;Shull,Sarah;Mackey,Katherine;Priest,KelseyC;Englander,Honora;Thoma,Jessica;Lovejoy,TravisI
阿片类药物使用障碍的药物治疗，包括丁丙诺啡和美沙酮，被认为是阿片类药物使用障碍（OUD）的金标准治疗。随着接受丁丙诺啡的患者数量的增加，临床医生越来越多地关注那些接受手术并需要管理围手术期疼痛的丁丙诺啡处方患者。Objective.DesignRetrospective队列研究利用来自VA公司数据仓库（CDW）的数据，一个国家级的病人数据库。在CDW中无法访问的数据，包括对患者修改丁丙诺啡剂量的临床指导，通过图表review. PropantsNational样本的患者通过退伍军人健康管理局接受护理。Main MeasuresWe报告描述性统计的发生率丁丙诺啡剂量举行之前，期间，并立即手术后，以及手术后的结果。多变量Logistic回归确定的社会人口和临床特征与围手术期hold.Key ResultsOur最终样本包括183例患者，其中大多数是白色和男性。大多数患者（66%）经历了围手术期丁丙诺啡剂量暂停：在术前、手术当天和术后期间，40%、62%和55%的患者暂停丁丙诺啡给药。对于在手术前一年经历无家可归/住房不安全的患者（aOR = 0.25; 95% CI 0.10-0.61）以及居住在农村地区的患者（aOR=0.29; 0.12-0.68），丁丙诺啡剂量暂停的可能性较小。在手术后的12个月内，122例（67%）被保留在丁丙诺啡，10例（5.5%）经历了过量，15（8.2%）had died.ConclusionsWe确定围手术期丁丙诺啡剂量持有率高。由于围手术期服用丁丙诺啡与新出现的临床建议不一致，并且存在重大风险，因此可能需要开展教育活动或其他针对提供者的干预措施，以确保OUD患者接受推荐的护理。
BackgroundMedication 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.ObjectiveTo describe practice patterns of perioperative and post-surgical use of buprenorphine among patients prescribed buprenorphine for OUD who experience major surgery.DesignRetrospective 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.ParticipantsNational sample of patients receiving care through the Veterans Health Administration.Main MeasuresWe 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 ResultsOur 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.ConclusionsWe 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.