Mismatched Postsurgical Opioid Prescription to Liver Transplant Patients: A Retrospective Cohort Study From a Single High-volume Transplant Center.

Autor:	Chen VJ; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.; Brown University, Providence, RI., Guan LS; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ., Bokoch MP; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA., Langnas E; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA., Kothari R; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA., Croci R; UCSF Health Informatics, University of California, San Francisco, San Francisco, CA., Campbell LJ; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.; University of the Incarnate Word School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX., Quan D; Department of Surgery, University of California, San Francisco, San Francisco, CA., Freise C; Department of Surgery, University of California, San Francisco, San Francisco, CA., Guan Z; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2024 Feb 01; Vol. 108 (2), pp. 483-490. Date of Electronic Publication: 2024 Jan 19.
DOI:	10.1097/TP.0000000000004728
Abstrakt:	Background: Improper opioid prescription after surgery is a well-documented iatrogenic contributor to the current opioid epidemic in North America. In fact, opioids are known to be overprescribed to liver transplant patients, and liver transplant patients with high doses or prolonged postsurgical opioid use have higher risks of graft failure and death. Methods: This is a retrospective cohort study of 552 opioid-naive patients undergoing liver transplant at an academic center between 2012 and 2019. The primary outcome was the discrepancy between the prescribed discharge opioid daily dose and each patient's own inpatient opioid consumption 24 h before discharge. Variables were analyzed with Wilcoxon and chi-square tests and logistic regression. Results: Opioids were overprescribed in 65.9% of patients, and 54.3% of patients who required no opioids the day before discharge were discharged with opioid prescriptions. In contrast, opioids were underprescribed in 13.4% of patients, among whom 27.0% consumed inpatient opioids but received no discharge opioid prescription. The median prescribed opioid daily dose was 333.3% and 56.3% of the median inpatient opioid daily dose in opioid overprescribed and underprescribed patients, respectively. Importantly, opioid underprescribed patients had higher rates of opioid refill 1 to 30 and 31 to 90 d after discharge, and the rate of opioid underprescription more than doubled from 2016 to 2019. Conclusions: Opioids are both over- and underprescribed to liver transplant patients, and opioid underprescribed patients had higher rates of opioid refill. Therefore, we proposed to prescribe discharge opioid prescriptions based on liver transplant patients' inpatient opioid consumption to provide patient-centered opioid prescriptions. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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