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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要杀蛋白使用障碍的药物（MOUD） - 鲍多诺宁，美沙酮和纳曲酮 - 非法opioid opioid 使用，增加治疗中的保留率并挽救生命。在美国，有270万人与阿片类药物相处在2021年，使用障碍和与阿片类药物相关的过量死亡总计超过80,000。尤其是丁丙诺啡，手术后急性疼痛的治疗是非常挑战。患者使用丁丙诺啡以及Metagadone的Moud会产生对阿片类镇痛药的耐受性。从历史上看定期指南提倡的患者在手术前暂时停止丁丙诺啡，不用担心继续丁丙诺啡会导致阿片类药物剂量的升级和无法治疗手术后的急性疼痛。但是，全国对话最近随着指南而变化建议在此期间继续进行丁丙诺啡和较小程度的方法adone 环境。支持这种变化的证据取决于小样本，非手术队列和研究无法检查疼痛和阿片类药物使用障碍的相关结果。结果，临床医生目前正在运作一个没有高质量证据的临床和政策环境，支持这些相互矛盾的准则这些易受攻击的阿片类药物使用障碍患者的围手术期护理。因此，严格研究如何保留对丁丙诺啡的疗法以及另外两个moud，会影响手术后的结局至关重要的是。在此提案中，我们将使用几个最先进的国家数据库来取得更好的成就了解丁丙诺啡和其他穆德的定期管理。这样，我们将检查丁丙诺啡治疗保留率对阿片类药物过量风险和其他相关健康的后果在周期性条件下，私人保险，医疗补助和医疗保险患者的结果。我们将将主要的重点放在丁丙诺啡上，还包括Metagadone，Naltrexone和MOUD混合使用对15岁及以上患者的分析，该年龄段的年龄段 OID使用障碍（老年青少年）的启动和OOid使用障碍诊断的迅速增加（较老成年人）。在AIM 1中，我们将描述手术对丁丙诺啡保留和保留的影响的变化其他MOUD疗法，同时提供有关MOUD治疗的国家模式的最新信息手术后保留。这些分析还将确定预测手术后治疗的因素。在AIM 2中，我们将评估手术后MOUD治疗保留率是否与术后有关 OOPIOED处方和临床结果。在AIM 3中，我们将评估是否在手术与阿片类药物过量事件和死亡率的降低有关。该提议的发现将告知努力，以优化丁丙诺啡和其他穆德的定期管理，并加速努力改善周期性护理并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。