The Impact of Surgery on Outcomes for Patients taking Medications for Opioid Use Disorder

手术对服用阿片类药物使用障碍患者的结果的影响

• 批准号: 10793072
• 负责人: Mark Bicket
• 金额: $ 66万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10793072
• 关键词: 15 year old; Acceleration; Acute; Acute Pain; Adolescent; Adverse event; Advocate; Age; American; Binding; Buprenorphine; Cessation of life; Clinical; Conflict (Psychology); Data; Data Analyses; Databases; Diagnosis; Dose; Elderly; Emergency department visit; Environment; Euphoria; Event; Expert Opinion; Failure; Formulation; Geographic Factor; Geography; Guidelines; Health; Health Care Costs; Heterogeneity; Hospitalization; Insurance; Knowledge; Knowledge Management; Length of Stay; Medicaid; Medicare; Medication Management; Methadone; Methods; Minor; Morbidity - disease rate; Naltrexone; Operative Surgical Procedures; Opioid; Opioid Analgesics; Opioid agonist; Outcome; Overdose; Pain; Pain management; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Perioperative; Perioperative Care; Persons; Policies; Postoperative Pain; Postoperative Period; Practice Guidelines; Predictive Factor; Prevalence; Privatization; Provider; Race; Recommendation; Research; Risk Reduction; Sampling; United States; Variant; addiction; age group; antagonist; cohort; comorbidity; experience; high risk; hospital readmission; illicit opioid; improved; interest; medical specialties; medication for opioid use disorder; mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose risk; pain outcome; patient retention; population based; pragmatic implementation; prescription opioid; prevent; provider factors; receptor; relapse risk; respiratory; surgical pain; treatment duration

PROJECT SUMMARY Medications for opioid use disorder (MOUD)–buprenorphine, methadone, and naltrexone–decrease illicit opioid use, increase retention in treatment, and save lives. In the United States, 2.7 million persons live with opioid use disorder and opioid-related overdose deaths totaled more than 80,000 in 2021. For patients taking MOUD, and buprenorphine in particular, the treatment of acute pain after surgery is very challenging. Patients on MOUD who use buprenorphine, as well as methadone, develop tolerance to opioid analgesics. Historically, perioperative guidelines have advocated that patients temporarily discontinue buprenorphine before surgery, out of concern that continuing buprenorphine would lead to escalation in opioid dosing and the inability to treat acute pain after surgery. However, the national conversation has recently shifted with guidelines recommending that buprenorphine, and to a lesser extent methadone, be continued in the perioperative setting. The evidence supporting this change has relied on small samples, non-surgical cohorts, and studies failing to examine relevant outcome for pain and opioid use disorder. As a result, clinicians currently operate in a clinical and policy environment with no high-quality evidence supporting these conflicting guidelines on the perioperative care for these vulnerable patients with opioid use disorder. Therefore, rigorous research on how retention to therapies of buprenorphine, as well as the two other MOUD, influences outcomes after surgery is critically needed. In this proposal, we will use several state-of-the-art national databases to achieve a better understanding of perioperative management of buprenorphine and other MOUD. In doing so, we will examine the consequences of buprenorphine therapy retention on opioid overdose risk and other relevant health outcomes among privately insured, Medicaid, and Medicare patients under perioperative conditions. We will focus primarily on buprenorphine, and also include methadone, naltrexone, and mixed MOUD use in this analysis of patients aged 15 years and above, which accounts for age groups that experience high risk for initiation of opioid use disorder (older adolescents) and rapid increases in opioid use disorder diagnoses (older adults). In Aim 1, we will delineate variation in the impact of surgery on the retention of buprenorphine and other MOUD therapies while providing the most up-to-date information on national patterns of MOUD treatment retention after surgery. These analyses will also identify factors that predict retention of treatment after surgery. In Aim 2, we will evaluate whether MOUD treatment retention after surgery is associated with postoperative opioid prescribing and clinical outcomes. In Aim 3, we will assess whether MOUD treatment retention after surgery is associated with reductions in opioid overdose events and mortality. Findings from this proposal will inform efforts to optimize the perioperative management of buprenorphine and other MOUD, and accelerate efforts to improve the perioperative care and reduce the negative consequences of opioid-related harms among patients living with opioid use disorder.

项目总结 治疗阿片使用障碍(MOUD)的药物-丁丙诺啡、美沙酮和纳曲酮-减少非法阿片类药物 使用，增加治疗中的保留率，拯救生命。在美国，有270万人服用阿片类药物 2021年，与使用障碍和阿片类药物相关的过量死亡总数超过8万人。对于服用Moud的患者， 尤其是丁丙诺啡，术后急性疼痛的治疗非常具有挑战性。病人在 使用丁丙诺啡和美沙酮的母亲对阿片类镇痛剂产生耐受性。从历史上看， 围手术期指南建议患者在手术前暂时停止丁丙诺啡， 出于担心持续丁丙诺啡将导致阿片类药物剂量上升和无法治疗 手术后的剧烈疼痛。然而，最近随着指导方针的出台，全国的对话发生了变化 建议丁丙诺啡和美沙酮在围手术期继续应用 布景。支持这一变化的证据依赖于小样本、非手术队列和研究。 未能检查疼痛和阿片类药物使用障碍的相关结果。因此，临床医生目前在 没有高质量证据支持这些相互矛盾的指南的临床和政策环境 这些阿片类药物使用障碍患者的围手术期护理。因此，对如何 丁丙诺啡以及另外两种Moud的保留治疗会影响手术后的结果 这是急需的。在这项提案中，我们将使用几个最先进的国家数据库来实现更好的 丁丙诺啡等药物的围手术期处理体会在此过程中，我们将研究 丁丙诺啡保留治疗对阿片类药物过量风险和其他相关健康的影响 私人保险、医疗补助和医疗保险患者在围手术期条件下的结果。我们会 主要关注丁丙诺啡，也包括美沙酮、纳曲酮和混合Moud在此使用 对15岁及以上的患者进行的分析，其中考虑到了患糖尿病风险较高的年龄组 阿片类药物使用障碍的开始(年龄较大的青少年)和阿片类药物使用障碍诊断的快速增加(年龄较大的青少年 成人)。在目标1中，我们将描述手术对丁丙诺啡和丁丙诺啡保留的影响的差异。 其他Moud疗法，同时提供关于Moud治疗国家模式的最新信息 手术后滞留。这些分析还将确定预测术后治疗保留的因素。 在目标2中，我们将评估术后Moud治疗滞留是否与术后相关 阿片类药物处方和临床结果。在目标3中，我们将评估Moud治疗后是否保留 手术与阿片类药物过量事件和死亡率的减少有关。这项提案的结果将 通报优化丁丙诺啡和其他MUD围手术期管理的努力，并加快 努力改善围手术期护理，减少阿片类药物相关危害的负面后果 在患有阿片类药物使用障碍的患者中。