Impact of a multidisciplinary multimodal opioid minimization initiative in kidney transplant recipients

Rohan, Vinayak; Taber, David J.; Patel, Neha; Perez, Caroline; Pilch, Nicole A.; Parks, Sara C.; Bolin, Eric D.; Nadig, Satish N.; Baliga, Prabhakar K.; Fleming, James N.

doi:10.1111/ctr.14006

Cited by 16 publications

(40 citation statements)

References 21 publications

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“…Although admittedly studies analyzing posttransplant COU have shown even stronger associations with clinical outcomes than pretransplant opioid use, we feel it is a more clinically and operationally achievable goal to identify at‐risk patients and attempt to implement interventions to prevent COU after transplant than it is to mitigate COU and prevent outcomes once it has become already established. Recently, a multidisciplinary multimodal approach to mitigate posttransplant opioid use has shown excellent early outcomes by significantly reducing daily inpatient opioid use (38.6 vs. 8 morphine milligram equivalents/day, p < 0.001) and decreasing opioid prescriptions at discharge from 96% to 5% ( p < 0.001), but further analysis with larger samples and longer term follow‐up on both opioid use and clinical outcomes are necessary 13 …”

Section: Discussionmentioning

confidence: 99%

The impact of pretransplant opioid exposure on healthcare utilization and costs in kidney transplant

et al. 2020

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Study Objective Opioid use has been associated with significant morbidity and mortality in the United States. Studies within kidney transplantation have also shown increased risk of mortality, graft loss, and complications in kidney transplant recipients who use opioids prior to transplant. The objective of this analysis was to identify if recent pretransplant opioid exposure would be an effective risk‐stratifier for patients at risk for readmissions and readmission costs. Further, the objective was to see if a brief assessment of recent opioid use could predict chronic opioid use post‐transplant.” Patients and Design This study was a single‐center, retrospective cohort analysis of adult renal transplant recipients between January 2010 and December 2016 assessing the impact of pretransplant opioid use on posttransplant readmissions at 1 year postsurgery, as well as it's ability to identify patients at risk of chronic opioid use post‐transplant. Opioid use was identified using medication reconciliation or a national prescription database, and readmissions and normalized costs for hospitalizations were identified via the Vizient clinical database. Main Results Pretransplant opioid exposure occurred in 271 (24%) of 1129 patients transplanted during the study time period. There were no differences in index hospitalization length of stay or cost; however, patients with opioid exposure were significantly more likely to have been admitted within 1‐year postsurgery (51 vs. 43%, p = 0.023), had more readmissions per patient (0.93 vs. 0.72, p = 0.010), and had higher normalized readmissions costs ($12,556 vs. $8344, p = 0.009). Patients with opioid exposure were also more likely to be admitted for readmissions, had more admissions per patient, and had higher readmission costs at 30 and 90 days postsurgery. There were no differences in preventability of readmissions between cohorts or in general causes of readmissions. A multivariable logistic regression demonstrated that being opioid experienced and having a history of diabetes mellitus were independently associated with readmissions at 1 year postsurgery. In addition, having opioid exposure at the time of transplant, a history of diabetes mellitus, and younger age were independently associated with chronic opioid use after transplant. Conclusion This study demonstrated that recent exposure to opioids prior to kidney transplant was significantly and independently associated with increased readmissions and readmission costs at multiple timepoints up to 1 year posttransplant as well as chronic opioid use after transplant.It also demonstrated that a brief assessment of recent opioid use may be able to identify patients at risk for chronic opioid use. Because opioid use is associated with multiple diseases, it is important to continue to study the association of opioid use, and the potential for disease‐modifying interactions, with various clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of pretransplant opioid exposure on healthcare utilization and costs in kidney transplant

et al. 2020

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“…Epidural anesthesia can be administered in these patients; however, its use is limited due to the hemodynamic effects and changes in coagulation. Regional methods, such as a transversus abdominis plane block, can be added to multimodal analgesia [37]. Similar to patients with kidney dysfunction, nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended in transplant recipients in the multimodal approach.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management of Patients Undergoing Renal Transplantation: A Review of A Two-year Experience

2020

Signa Vitae

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Objectives: This study reviewed the anesthetic management procedures used for renal transplantation patients at a university hospital in Turkey over a two-year period. Areas of interest included preoperative status, fluid management, perioperative complications, and postoperative analgesia. Methods: A retrospective review of hospital records and information collected from all patients undergoing renal transplantation, performed at Ondokuz Mayıs University Hospital from 2018 to 2020, was conducted. Results: A total of 90 renal transplants were performed during the study time period. Of the patients undergoing renal transplantation, 44.4% were female and 55.6% were male. 52 patients were recipients of cadaveric transplants and 38 patients received kidneys from living, related donors. The duration of surgery and cold ischemic time were longer in the recipients of the cadaveric transplants (p < 0.05). Delayed graft function was statistically significantly higher in the kidney transplants obtained from the cadaveric donors than the living donors (p < 0.05). Conclusions: This study showed that anesthesia for renal transplantation is a safe and effective method if a selected range of drugs and techniques is used. Applying a well-planned standard anesthesia protocol and updating it periodically in line with the current literature will contribute to improving the quality of the outcomes renal transplantation surgery.

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“…Compared with the historical cohort (n = 48), the mean inpatient opioid dose was reduced with the protocol (8.0 vs 38.6 morphine mg equivalent/day, P < .001), and fewer patients were discharged with an opioid prescription (5% vs 96%, P < .001). 32 Multimodal analgesic regimens for kidney transplants often include TAP or QL blocks. Kolacz et al studied the impact of TAP versus QL on the postoperative opioid.…”

Section: Pain Managementmentioning

confidence: 99%

“…Multimodal analgesia and patient education may reduce the need for inpatient opioid administration and opioid prescriptions on discharge, which may provide long-term benefit. 31,32…”

Section: Pain Managementmentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2020

Wang

Fagelman

Sakai

2021

Semin Cardiothorac Vasc Anesth

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In 2020, we identified and screened over 490 peer-reviewed publications on pancreatic transplantation, over 500 on intestinal transplantation, and over 5000 on kidney transplantation. The liver transplantation section specially focused on clinical trials and systematic reviews published in 2020 and featured selected articles. This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We explore a wide range of topics, including COVID-19 and organ transplantation, risk factors and outcomes, pain management, artificial intelligence, robotic donor surgery, and machine perfusion.

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Impact of a multidisciplinary multimodal opioid minimization initiative in kidney transplant recipients

Cited by 16 publications

References 21 publications

The impact of pretransplant opioid exposure on healthcare utilization and costs in kidney transplant

The impact of pretransplant opioid exposure on healthcare utilization and costs in kidney transplant

Anesthetic Management of Patients Undergoing Renal Transplantation: A Review of A Two-year Experience

Abdominal Organ Transplantation: Noteworthy Literature in 2020

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