D. C. Cron1, H. Hu1, J. S. Lee1, C. M. Brummett2, J. F. Waljee1, M. J. Englesbe1, C. J. Sonnenday1 2University Of Michigan Medical School,Anesthesiology,Ann Arbor, MI, USA 1University Of Michigan Medical School,Surgery,Ann Arbor, MI, USA
Introduction:
Prolonged opioid use following surgical procedures is common. End-stage liver disease is associated with painful comorbidities, and liver transplant recipients may be at risk of postoperative prolonged opioid use. We studied the incidence and predictors of prolonged opioid use following hospital discharge after liver transplantation.
Methods:
Using a national dataset of employer-based insurance claims, we identified N=1821 adults who underwent liver transplantation between 12/2009 and 8/2015. Prolonged opioid use was defined as patients who filled an opioid prescription within two weeks of post-transplant hospital discharge, and also filled ≥1 opioid prescription between 90-180 days post-discharge. We stratified our analysis by preoperative opioid use status: opioid-naïve, chronic opioid use (≥120 days supply in the year before transplant, or ≥3 opioid prescriptions in the 3 months before surgery), and intermittent use (all other non-chronic use). We also investigated demographics, comorbidities, liver disease etiology, and hospital length of stay (LOS) as potential predictors of prolonged use. We used multivariate logistic regression to compute covariate-adjusted incidence of prolonged opioid use.
Results:
In the year before liver transplantation, 55% of patients were opioid-naïve, 34% had intermittent use, and 11% had chronic use. Overall, 47% of transplant recipients filled an opioid within 2 weeks of hospital discharge, and 19% of all patients had prolonged use. The adjusted rate of prolonged opioid use was 8-fold higher among preoperative chronic opioid users compared to opioid-naïve (61% vs. 8%, P<0.001, Figure). Among preoperatively opioid-naïve patients, predictors of prolonged post-transplant opioid use included: hospital LOS <21 days (Odds ratio [OR]=1.93, P=0.013) and any psychiatric comorbidity (OR=1.8, P=0.030). Age, gender, insurance type, medical comorbidities, and liver disease etiology were not predictive of prolonged opioid use.
Conclusion:
Opioid use remains common beyond 90 days after post-liver transplant hospital discharge, with particularly high rates among preoperative chronic opioid users. Close outpatient follow-up and coordination of care is necessary post-transplant to optimize pain control and decrease rates of prolonged opioid use.
