Perioperative care for patients with opioid exposure and opioid use disorder: screening and treatment strategies.

Mark C Bicket; Brittany Ervin-Sikhondze; Jennifer F Waljee

doi:10.1097/aco.0000000000001698

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Perioperative care for patients with opioid exposure and opioid use disorder: screening and treatment strategies.

Mark C Bicket·Brittany Ervin-Sikhondze·Jennifer F Waljee

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Abstract

PURPOSE OF REVIEW: The prevalence of opioid tolerance, dependence, and use disorder is increasing among patients presenting for surgical care, yet perioperative management strategies for these patients remain inconsistent. This review examines the impact of preoperative opioid exposure on surgical outcomes, the scope of untreated opioid use disorder (OUD) among surgical patients, and advances in clinical and systems-level approaches to perioperative care. RECENT FINDINGS: Preoperative opioid exposure independently predicts worse surgical outcomes, including higher opioid consumption, readmissions, complications, and mortality, in a dose-dependent manner. Perioperative opioid exposure predicts persistent opioid use after surgery, with the duration of exposure a stronger predictor of subsequent OUD than daily dose. Data-driven prescribing guidelines and structured opioid tapering reduce overprescribing without compromising pain control. Among surgical patients with diagnosed OUD, approximately two-thirds do not receive medications for opioid use disorder (MOUD), though treatment engagement and maintenance substantially improve outcomes. Evidence now clearly supports perioperative buprenorphine continuation over interruption. SUMMARY: Effective perioperative management of opioid-complex surgical patients requires systematic screening, evidence-based prescribing, MOUD continuation, and institutional infrastructure. The primary barrier is shifting from evidence generation to implementation.

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Humans Opioid-Related Disorders Perioperative Care Analgesics, Opioid Postoperative Pain Buprenorphine Opiate Substitution Treatment Pain Management Practice Guidelines as Topic Practice Patterns, Physicians'Drug Tapering buprenorphine medications for opioid use disorder opioid prescribing opioid use disorder perioperative pain management Journal Article Review

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Mark C Bicket, Brittany Ervin-Sikhondze, Jennifer F Waljee. 2026-08-05. Perioperative care for patients with opioid exposure and opioid use disorder: screening and treatment strategies.. https://doi.org/10.1097/aco.0000000000001698

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Journal Article; Review resource Analgesics, Opioid subject Buprenorphine subject Humans subject Journal Article subject Opioid-Related Disorders subject Pain Management subject Perioperative Care subject Postoperative Pain subject

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