No abstract

Background: Given the ongoing opioid epidemic and desire to optimize recovery after surgery, a novel opioidminimization protocol (OMP) was implemented for liver transplantation (LT) recipients at our institution. This pilot study evaluated OMP feasibility, pain control impact, and patient satisfaction. Methods: Starting January 2019, all LT recipients received OMP, including perioperative acetaminophen, gabapentin, opioid-sparing anesthesia, and expedited transition to tramadol if needed. Oxycodone was reserved for uncontrolled pain. Recipients were categorized by discharge pain protocol: (A) OMP with rescue tramadol for breakthrough, (B) failed OMP with subsequent oxycodone-based regimen, or (N/A) if not opioid-naïve preoperatively. The ACS Safe Pain Control Patient Evaluation was completed at follow-up. Outpatient prescription data within 30 days of discharge were reviewed for patients who were discharged home, excluding those discharged to a rehabilitation facility. Discharge regimen was compared to historical controls January-July 2018. Results: Of 144 patients, 27 were (N/A) and therefore excluded from analysis. Of the remaining 117 patients, category (A) comprised 57/67 (85.1%) of OMP group versus only 9/50 (18.0%) of controls. No differences in demographics, comorbidities, length of stay, or readmissions were identified between OMP and controls. Within the OMP group, category (A) patients were more often white than category (B) (94.7% vs 70.0%, p=0.01). Median morphine milligram equivalents (MME) at discharge was lower with OMP versus controls (280 vs 338, p<0.01). Within the OMP patients discharged to home, 7/43 (16.3%) category (A) patients were opioid-free while 36/43 (83.7%) required rescue tramadol, with