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.

项目概要治疗阿片类药物使用障碍 (MOUD) 的药物——丁丙诺啡、美沙酮和纳曲酮——减少非法阿片类药物的使用在美国，有 270 万人服用阿片类药物。 2021 年，使用障碍和阿片类药物过量相关死亡人数总计超过 80,000 人。对于服用 MOUD 的患者，尤其是丁丙诺啡，手术后急性疼痛的治疗对患者来说非常具有挑战性。使用丁丙诺啡和美沙酮的 MOUD 会产生对阿片类镇痛药的耐受性。围手术期指南主张患者在手术前暂时停用丁丙诺啡，出于担心持续使用丁丙诺啡会导致阿片类药物剂量增加以及无法治疗然而，全国范围内的话题最近发生了变化，并提出了指导方针。建议围手术期继续使用丁丙诺啡，并在较小程度上使用美沙酮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。临床和政策环境没有高质量的证据支持这些相互矛盾的指南因此，如何对这些易受阿片类药物使用障碍的患者进行围手术期护理。保留丁丙诺啡以及其他两种 MOUD 治疗会影响手术后的结果在这项提案中，我们将使用几个最先进的国家数据库来实现更好的目标。了解丁丙诺啡和其他 MOUD 的围手术期管理。在此过程中，我们将进行研究。丁丙诺啡治疗保留对阿片类药物过量风险和其他相关健康的影响我们将在围手术期条件下评估私人保险、医疗补助和医疗保险患者的结果。主要关注丁丙诺啡，还包括美沙酮、纳曲酮和 MOUD 的混合使用对 15 岁及以上患者的分析，其中考虑了经历高风险的年龄组阿片类药物使用障碍的开始（老年青少年）和阿片类药物使用障碍诊断的快速增加（老年在目标 1 中，我们将描述手术对丁丙诺啡保留的影响的变化。其他 MOUD 疗法，同时提供有关国家 MOUD 治疗模式的最新信息这些分析还将确定预测术后保留治疗的因素。在目标 2 中，我们将评估手术后 MOUD 治疗保留是否与术后在目标 3 中，我们将评估 MOUD 治疗后是否保留。手术与减少阿片类药物过量事件和死亡率有关。通知优化丁丙诺啡和其他 MOUD 的围手术期管理工作，并加速改善围手术期护理工作并减少阿片类药物相关危害的负面后果患有阿片类药物使用障碍的患者。