Variation in opioid prescribing patterns after abdominal transplant surgery.

Abstract

Opioids are associated with negative transplant outcomes. We sought to identify patient and center effects on over-prescribing of opioids(>200 OME (oral morphine equivalents)). Clinical and opioid prescription data (2014-2017) were collected from three academic transplant centers for kidney (KT), liver (LT), and simultaneous liver-kidney transplant (SLK) patients. Multivariable models were used to identify predictors of opioid over-prescribing at discharge and the occurrence of refill prescriptions at 90 days. Three-thousand seven-hundred and two patients underwent transplant in the cohort (KT: n=2358, LT: n=1221, SLK: n=123). More than 80% of recipients were over-prescribed opioids at discharge (Median OME (mOME)=300 (IQR 225-375). LT and SLK had the largest prescription size (LT mOME 338 (IQR 300-450); SLK mOME 338 (IQR 225-450) and refill rate (LT: 64%, SLK 59%) (all, P<.001). Multivariable analysis indicated that transplant center was a significant predictor of opioid over-prescription after KT and LT (all, P<.001); older age (in KT) and length of stay (LOS) (in LT) were protective factors (both, P<.05). Refill occurrence was associated with initial prescription size and was reduced by older age and initial LOS (all, P<.05). The wide variation in opioid prescribing patterns has implications for transplant practice innovation, guideline development, and further study.