• Jessica J Wyse, Anders Herreid-O'Neill, Jacob Dougherty, Sarah Shull, Katherine Mackey, Kelsey C Priest, Honora Englander, Jessica Thoma, and Travis I Lovejoy.
• Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA. Jessica.Wyse@va.gov.
• J Gen Intern Med. 2022 Sep 1; 37 (12): 299830042998-3004.

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.© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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