Chronic opioid use and clinical outcomes in lung transplant recipients: A single‐center cohort study

Drees, David; Tumin, Dmitry; Miller, Rebecca; Kirkby, Stephen; Bhalla, Tarun; Tobias, Joseph D.; Hayes, Don

doi:10.1111/crj.12948

Cited by 14 publications

(7 citation statements)

References 37 publications

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“…A second study of 70 942 adolescents and young adults who were opioid-naive (70% ≤18 years old) found that a filled perioperative opioid prescription after wisdom tooth extraction was associated with 2.7 higher odds of persistent opioid use compared with those who did not fill an opioid prescription after extraction . Additional studies assessing development of long-term opioid use after surgery are limited to specific diagnoses limiting generalization …”

Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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IMPORTANCEOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

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Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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“…In contrast, other studies have reported a 30-50% rate of discharge with opioids, suggesting a potential benefit to adjunct therapies in reducing the duration of acute post-thoracotomy pain and the need for further opioids. 10,23,24 Lastly, patients treated with this protocol had a relatively short duration of stay in the ICU and hospital (10 days vs. median 18 days nationally or 16 days for UNOS Region 9) and similar readmission rates (36% vs. 33-45% in other cohorts). [25][26][27] The effect of adjunctive analgesics on PTPS remains to be determined.…”

Section: Discussionmentioning

confidence: 98%

“…However, the low daily opioid dose may have limited the ability to detect a difference, as outcomes have historically been worse in heavy opioid users 8,9 . In contrast, post lung transplant opioid dependence has been linked with increased mortality and worse lung function, and many patients remain on opioids chronically 10,19 . These studies highlight the need to carefully screen for opioid use pre‐transplant and also to minimize opioid use post‐transplant to avoid any negative effects on graft and patient survival.…”

Section: Discussionmentioning

confidence: 99%

“…Opioid analgesics have numerous adverse effects detrimental to post‐lung transplant recovery–sedation, respiratory depression, nausea/vomiting, and ileus. Moreover, opioids are associated with increased risk of graft loss and mortality in many transplant populations, including lung transplant recipients 8–10 . To date, thoracic epidural analgesia (TEA) has been the cornerstone of post‐lung transplant analgesia due to evidence it decreases duration of mechanical ventilation and ICU LOS 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, opioids are associated with increased risk of graft loss and mortality in many transplant populations, including lung transplant recipients. [8][9][10] To date, thoracic epidural analgesia (TEA) has been the cornerstone of post-lung transplant analgesia due to evidence it decreases duration of mechanical ventilation and ICU LOS. 11 Yet, there is concern for epidural abscess in immunosuppressed patients, epidural hematoma in anticoagulated patients, and restrictions limiting post-operative physical rehabilitation.…”

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confidence: 99%

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Multimodal opioid‐sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block

Lewis

Sureau

Katz

et al. 2021

Clinical Transplantation

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Opioid analgesics are commonly used post-lung transplant, but have many side effects and are associated with worse outcomes. We conducted a retrospective review of all lung transplant recipients who were treated with a multimodal opioid-sparing pain protocol. The use of liposomal bupivacaine intercostal nerve block was variable due to hospital restrictions. The primary objective was to describe opioid requirements and patient-reported pain scores early post-lung transplant and to assess the impact of intraoperative liposomal bupivacaine intercostal nerve block. We treated 64 lung transplant recipients with our protocol. Opioid utilization decreased to a mean of 43 milligram oral morphine equivalents by postoperative day 4. Median pain scores peaked at 4 on postoperative day 1 and decreased thereafter. Only three patients were discharged home with opioids, all of whom were taking opioid agonist therapy pretransplant for opioid use disorder. Patients who received liposomal bupivacaine intercostal nerve block in the operating room had a significant reduction in opioid consumption over postoperative day 1 through 4 (228 mg vs. 517 mg, P= .032). A multimodal opioid-sparing pain management protocol is feasible and resulted in weaning of opioids prior to hospital discharge.

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Long-term Outcomes Following a Comprehensive Quality Assurance and Process Improvement Endeavor to Minimize Opioid Use After Kidney Transplant

et al. 2023

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ImportanceOpioid use following kidney transplant is associated with an increased risk of graft loss and mortality. Opioid minimization strategies and protocols have shown reductions in short-term opioid use after kidney transplant.ObjectiveTo evaluate the long-term outcomes associated with an opioid minimization protocol following kidney transplant.Design, Setting, and ParticipantsThis single-center quality improvement study evaluated postoperative and long-term opioid use before and after the implementation of a multidisciplinary, multimodal pain regimen and education process in adult kidney graft recipients from August 1, 2017, through June 30, 2020. Patient data were collected from a retrospective chart review.ExposuresPreprotocol and postprotocol implementation use of opioids.Main Outcomes and MeasuresBetween November 7 and 23, 2022, opioid use before and after protocol implementation was evaluated up to 1 year after transplant using multivariable linear and logistic regression.ResultsA total of 743 patients were included, with 245 patients in the preprotocol group (39.2% female and 60.8% male; mean [SD] age, 52.8 [13.1 years]) vs 498 in the postprotocol group (45.4% female and 54.6% male; mean [SD] age, 52.4 [12.9 years]). The total morphine milligram equivalents (MME) in the 1-year follow-up in the preprotocol group was 1203.7 vs 581.9 in the postprotocol group. In the postprotocol group, 313 patients (62.9%) had 0 MME in the 1-year follow-up vs 7 (2.9%) in the preprotocol group (odds ratio [OR], 57.52; 95% CI, 26.55-124.65). Patients in the postprotocol group had 99% lower odds of filling more than 100 MME in the 1-year follow-up (adjusted OR, 0.01; 95% CI, 0.01-0.02; P &lt; .001). Opioid-naive patients postprotocol were one-half as likely to become long-term opioid users vs preprotocol (OR, 0.44; 95% CI, 0.20-0.98; P = .04).Conclusions and RelevanceThe study’s findings show a significant reduction in opioid use in kidney graft recipients associated with the implementation of a multimodal opioid-sparing pain protocol.

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Chronic opioid use and clinical outcomes in lung transplant recipients: A single‐center cohort study

Cited by 14 publications

References 37 publications

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Multimodal opioid‐sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block

Long-term Outcomes Following a Comprehensive Quality Assurance and Process Improvement Endeavor to Minimize Opioid Use After Kidney Transplant

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