Most Veterans Affairs Patients Receiving Buprenorphine Had Their Medication Withheld Perioperatively

Best practices for perioperative management of buprenorphine among patients with opioid use disorder (OUD) are uncertain. This study retrospectively examined a national sample of US Veterans Administration patients who were prescribed buprenorphine for OUD and underwent a surgical procedure that required hospitalization in 2018. Investigators reviewed medical records to identify whether buprenorphine was held before, during, and after surgery, and then determined post-surgical outcomes.

  • Of the 183 patients included, 66% had their buprenorphine held for surgery (62% and 55% received no buprenorphine on the day of and day following surgery, respectively).
  • Patients with housing insecurity and those living in rural areas were less likely than others to have buprenorphine held for surgery.
  • Buprenorphine treatment retention at 1, 6, and 12 months post-surgery was: 87%, 75%, and 67%, respectively.
  • 8% of patients returned to substance use within 1 month post-surgery.
  • 6% of patients had an overdose and 8% died within 12 months post-surgery.

Comments: Surgery can destabilize buprenorphine treatment. More clinicians and institutions are recommending buprenorphine continuation throughout the perioperative period, but these practices may not be consistently applied. This study did not directly investigate the effects of holding buprenorphine perioperatively, but the relatively high frequency of buprenorphine treatment discontinuation, overdose, and death deserve additional investigation. Overdose mortality dramatically increases when people with OUD discontinue buprenorphine; therefore, avoiding treatment discontinuation should be a high priority.

Aaron Fox, MD

Reference: Wyse JJ, Herreid-O’Neill A, Dougherty J, et al. Perioperative management of buprenorphine/naloxone in a large, national health care system: a retrospective cohort study. J Gen Intern Med. 2021;10.1007/s11606-021-07118-4.

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