{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T12:33:56Z","timestamp":1782995636933,"version":"3.54.5"},"reference-count":28,"publisher":"BMJ","issue":"7","funder":[{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["KL2TR002539"],"award-info":[{"award-number":["KL2TR002539"]}]},{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["UL1TR002538"],"award-info":[{"award-number":["UL1TR002538"]}]},{"DOI":"10.13039\/100019294","name":"Office of Rural Health","doi-asserted-by":"publisher","award":["14434"],"award-info":[{"award-number":["14434"]}],"id":[{"id":"10.13039\/100019294","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,4,17]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The USA provides medical services to its military veterans through Veterans Health Administration (VHA) medical centers. Passage of recent legislation has increased the number of veterans having VHA-paid orthopedic surgery at non-VHA facilities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective cohort study among veterans who underwent orthopedic joint surgery paid for by the VHA either at the Salt Lake City VHA Medical Center (VAMC) or at non-VHA hospitals between January 2018 and December 2021. 562 patients were included in the study, of which 323 used a non-VHA hospital and 239 patients the VAMC. The number of opioid tablets prescribed at discharge, the total number prescribed by postdischarge day 90, and the number of patients still filling opioid prescriptions between 90 and 120 days after surgery were compared between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Veterans who underwent orthopedic surgery at a non-VHA hospital were prescribed more opioid tablets at discharge (median (IQR)); (40 (30\u201360) non-VHA vs 30 (20\u201347.5) VAMC, p&lt;0.001) and in the first 90 days after surgery than patients who had surgery at the Salt Lake City VAMC (60 (40\u2013120) vs 35 (20\u201360), p&lt;0.001). Patients who had surgery at Salt Lake City VAMC were also significantly less likely to fill opioid prescriptions past 90 days after hospital discharge (OR (95% CI) 0.06 (0.01 to 0.48), p=0.007).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These results suggest that veterans who have surgery at a veterans affairs hospital with a transitional pain service are at lower risk for larger opioid prescriptions both at discharge and within 90 days after surgery as well as persistent opioid use beyond 90 days after discharge than if they have surgery at a community hospital.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-105162","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T10:35:14Z","timestamp":1714214114000},"page":"531-537","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Postsurgical opioid prescribing among veterans using community care for orthopedic surgery at non-VA hospitals compared to a VA hospital with a transitional pain service: a retrospective cohort study"],"prefix":"10.1136","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-1461","authenticated-orcid":false,"given":"Michael Jacob","family":"Buys","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA"},{"name":"Anesthesiology, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Anderson","sequence":"additional","affiliation":[{"name":"Anesthesiology, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberlee","family":"Bayless","sequence":"additional","affiliation":[{"name":"Anesthesiology, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela P","family":"Presson","sequence":"additional","affiliation":[{"name":"Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Hales","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3521-3749","authenticated-orcid":false,"given":"Benjamin Sands","family":"Brooke","sequence":"additional","affiliation":[{"name":"Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,27]]},"reference":[{"key":"2025101111480014000_50.7.531.1","unstructured":"Congress . MISSION act congressional bill. n.d. Available: www.congress.gov\/bill\/115th-congress\/senate-bill\/2372\/text"},{"key":"2025101111480014000_50.7.531.2","unstructured":"Congressional Budget Office . The veterans community care program: background and early effects. 2021. Available: https:\/\/www.cbo.gov\/publication\/57257 [Accessed 07 Oct 2022]."},{"key":"2025101111480014000_50.7.531.3","doi-asserted-by":"crossref","first-page":"426","DOI":"10.7326\/M18-1540","article-title":"Veterans health administration hospitals outperform non\u2013veterans health administration hospitals in most health care markets","volume":"170","author":"Weeks","year":"2019","journal-title":"Ann Intern Med"},{"key":"2025101111480014000_50.7.531.4","doi-asserted-by":"crossref","first-page":"S270","DOI":"10.1097\/MLR.0000000000001490","article-title":"Did access to care improve since passage of the veterans choice act?","volume":"59","author":"Gurewich","year":"2021","journal-title":"Med Care"},{"key":"2025101111480014000_50.7.531.5","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/MLR.0000000000001472","article-title":"Does community outsourcing improve timeliness of care for veterans with obstructive sleep apnea?","volume":"59","author":"Kaul","year":"2021","journal-title":"Med Care"},{"key":"2025101111480014000_50.7.531.6","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1111\/1475-6773.13320","article-title":"Comparing cataract surgery complication rates in veterans receiving VA and community care","volume":"55","author":"Rosen","year":"2020","journal-title":"Health Serv Res"},{"key":"2025101111480014000_50.7.531.7","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.33259","article-title":"Association of quality of care with where veterans choose to get knee replacement surgery","volume":"5","author":"Giori","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2025101111480014000_50.7.531.8","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/MLR.0000000000001678","article-title":"Comparing postoperative readmission rates between veterans receiving total knee arthroplasty in the veterans health administration versus community care","volume":"60","author":"Rosen","year":"2022","journal-title":"Med Care"},{"key":"2025101111480014000_50.7.531.9","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1377\/hlthaff.2020.01679","article-title":"Comparing complication rates after elective total knee arthroplasty delivered or purchased by the VA","volume":"40","author":"Harris","year":"2021","journal-title":"Health Affairs"},{"key":"2025101111480014000_50.7.531.10","unstructured":"R Core Team . 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