Variation in opioid prescribing patterns after abdominal transplant surgery

Area of Science:

• Transplant medicine
• Pharmacology
• Health services research

Background:

• Opioid use is linked to adverse outcomes in transplant recipients.
• Over-prescribing of opioids, defined as >200 oral morphine equivalents (OME), is a concern.

Purpose of the Study:

• To identify patient and transplant center factors contributing to opioid over-prescribing.
• To analyze predictors of opioid refill prescriptions at 90 days post-transplant.

Main Methods:

• Retrospective analysis of clinical and opioid prescription data from 2014-2017.
• Data collected from three academic centers for kidney, liver, and simultaneous liver-kidney transplant recipients.
• Multivariable models used to identify predictors of over-prescribing and refill occurrence.

Main Results:

• Over 80% of 3,702 transplant recipients received >200 OME at discharge.
• Liver and simultaneous liver-kidney transplant recipients had larger initial opioid prescriptions and higher refill rates.
• Transplant center was a significant predictor of over-prescription; older age and longer length of stay were protective against refills.

Conclusions:

• Significant variability exists in opioid prescribing patterns across transplant centers.
• Findings suggest a need for practice innovation and guideline development to optimize opioid management in transplant care.