Poster Presentation: Impact of Preoperative Assessment for Patients on Buprenorphine, Methadone, and Naltrexone-Impact of Preoperative Assessment for Patients on Buprenorphine, Methadone, and Naltrexone

Impact of Preoperative Assessment for Patients on Buprenorphine, Methadone, and Naltrexone

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A study by the Mayo Foundation for Medical Education and Research conducted a single-center retrospective review of electronic health records from adult patients treated with methadone, buprenorphine, and naltrexone who underwent elective surgery at Mayo Clinic-Rochester from January 2010 to December 2020. The research focused on perioperative outcomes comparing patients who received Preoperative Evaluation (POE) Clinic assessments with those who did not. A sub-analysis distinguished outcomes for those using these medications for substance use disorder (SUD) versus chronic pain.<br /><br />The study identified significant adverse postoperative outcomes in patients with chronic pain and SUD, such as heightened postoperative pain, delayed wound healing, extended hospital stays, higher readmission rates, and elevated mortality risks. For SUD patients, additional risks include withdrawal, relapse, and overdose. Specialized perioperative care is critical for these populations due to their unique needs.<br /><br />The data showed that patients with chronic pain who had a POE visit received significantly more perioperative multimodal analgesics than those who did not. Both chronic pain and SUD patients with POE consultations experienced fewer perioperative complications and readmissions within 30 days, although these results were not statistically significant but considered clinically meaningful. This suggests improved postoperative outcomes and potential cost savings for the institution.<br /><br />Despite these benefits, POE clinic utilization was markedly low, with only about a third of chronic pain patients and a quarter of SUD patients undergoing preoperative evaluation. The study indicates the need for a standardized preoperative assessment process for these patients to enhance surgical outcomes.<br /><br />The study's limitations include its retrospective design, reliance on historical data, and a new electronic medical record system's implementation partway through the reviewed period, potentially affecting documentation. Additionally, the study may lack broad generalizability due to its single-center nature, limited diversity in the patient population, and small sample size after applying exclusion criteria.<br /><br />The study concludes that formal POE can significantly aid in crafting a multimodal analgesic approach, decreasing perioperative complications, and readmission rates. It calls for further research with larger, more diverse sample sizes to better assess the impact of POE on patients treated with methadone, buprenorphine, and naltrexone.

Keywords

Mayo Foundation

perioperative outcomes

elective surgery

Preoperative Evaluation Clinic

chronic pain

substance use disorder

multimodal analgesics

postoperative complications

readmission rates

retrospective study