Opioid Utilization In Kidney Transplant Patients
*Olivia F. Lynch, *Alexa D. Melucci, *M. Katherine Dokus, *Jeremy C. Taylor, *Roberto Hernandez Alejandro, *Randeep S. Kashyap, *Jacob Moalem
University of Rochester, Rochester, NY
OBJECTIVE(S): In the process of a departmental analysis to understand opioid utilization and subsequently decrease narcotic use, we discovered kidney donor and transplant patients to be high outliers. We compared their opioid utilization and prescriptions to patients undergoing similar non-transplant procedures and investigated potential contributing factors.
METHODS: 97 adult patients who underwent minimally invasive (MIS) donor nephrectomy (DN, n=33) or open kidney transplantation (KT, n=64) from 01/2019-12/2019 were included. A randomly matched cohort of 97 general surgery (GS) patients (33 MIS, 64 open) who underwent similar procedures -MIS and open resection of the pancreas, liver, colon, and rectum— were selected for our comparison group. Chronic opioid users were excluded. Discharge prescriptions, inpatient opioid utilization, final 48-hour (48h) inpatient pain score, and hospital length of stay (LOS) were extracted from medical records.
RESULTS: We found that inpatient narcotic utilization was similar between transplant patients and their GS counterparts. Both total utilization and average daily narcotic use was similar between DN and KT patients. These similarities persisted when comparing DN to MIS GS patients, and KT to open GS patients.
While inpatient narcotic utilization was similar, we found that transplant patients were discharged home with significantly more opioid pills than their GS counterparts (Table 1), with donors exceeding transplant recipients. Both DN and KT had a median discharge pill number two times higher than their comparison groups (30 vs. 15 pills and 20 vs. 10 pills respectively, p<0.001; p=0.005 for DN vs. KT). There was no association between discharge prescription quantity and transplant patients’ LOS, final 48h pain scores, or final 48h MEQ (DN R2=0.16, 0.014, 0.07; KT R2=0.06, 0.16, 0.18, respectively).
CONCLUSIONS: While inpatient narcotic utilization was similar, patients undergoing donor nephrectomy or kidney transplantation were discharged with twice as many narcotic pills as their general surgery counterparts. Furthermore, we found no association between discharge prescriptions and inpatient factors. As a result, a quality improvement project is ongoing to decrease narcotic prescription in this population.
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