Post-Operative Opiate Utilization and Prescribing Patterns in Living Kidney Donors
1Transplant Surgery, Mayo Clinic, Phoenix, AZ, 2Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 3Transplant Surgery, Mayo Clinic, Rochester, MN, 4Department of Urology, Mayo Clinic, Phoenix, AZ, 5Transplant Surgery, Mayo Clinic, Jacksonville, FL
Meeting: 2020 American Transplant Congress
Abstract number: 136
Keywords: Kidney, Kidney transplantation, Pain
Session Information
Session Name: Kidney Living Donor: Other I
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 4:15pm-4:27pm
Location: Virtual
*Purpose: Living kidney donors (LKDs) become exposed to opioids during routine post-surgical care, which may lead to adverse outcomes. and since there is an absence of prescribing guidelines for this population, we aimed to determine patterns of opiate utilization and prescription among LKDs across transplant centers.
*Methods: We conducted a retrospective cohort study across three high-volume academic transplant centers from 2014-2017 to evaluate differences in opiate prescribing practices, usage patterns, and outcomes in living kidney donors based on demographic data, hospital, and pre-operative opioid usage, and previous national recommendations for postoperative opioid use (200 oral morphine equivalents (OME)). Univariate statistics were applied.
*Results: 899 patients underwent laparoscopic donor nephrectomy across the three centers; (opioid naïve (ON) n=873; opioid tolerant (OT) n=26). Median length of stay was 2 days overall. OT status varied by 3.7-fold across centers (1.9% vs. 1.6% vs 5.9%, p=0.005). Across centers, there were no significant differences in LKD demographics. 97.6% of LKDs were dismissed from the hospital with an opiate prescription, which varied by OT status (ON 98.5% vs. OT 65.4%, p<0.0001). Median OME prescribed was 225 OME (ON 225 vs OT 150, p<0.001). 11% of LKDs needed opioid prescription refills. 58.8% of all LKDs were prescribed more than 200 OME at dismissal (ON 59.7% vs. OT 30.8%, p=0.003), which varied significantly by center (center A, B, C: 48.6% vs 91.1% vs 65.3%, p<0.001).
*Conclusions: Compared to national guidelines, opiates were widely over-prescribed for LKDs in multiple centers. Novel guidelines for prescribing opiates to LKDs and pain management are needed.
| Characteristic | Opioid Naive N=873 |
Opioid Tolerant N=26 | Total N=899 |
P Value | |
| Age Group | 18-34 35-49 50-64 65-79 >80 |
22% 40% 33% 6% 0% |
8% 39% 39% 12% 4% |
22% 40% 33% 6% 0.1% |
0.001 |
| Sex | Male Female |
38% 62% |
46% 54% |
38% 62% |
0.38 |
| LOS (Days) | 1.97(1-7) | 1.62 (1-3) | 1.96(1-7) | 0.008 | |
| Opioid Rx at Dismissal | 99% | 65% | 98% | <0.001 | |
| Opioid Refill Rx | 11% | 8% | 11% | 0.096 | |
| Median OME at Dismissal | 225 (150,300) | 150 (0, 225) | 225 (150,300) | <0.001 | |
| OME > 200 | 60% | 31% | 59% | 0.003 | |
To cite this abstract in AMA style:
Calderon E, Ubl DS, Jadlowiec C, Dean P, Castle E, Andrews P, Taner B, Habermann E, Mathur AK. Post-Operative Opiate Utilization and Prescribing Patterns in Living Kidney Donors [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/post-operative-opiate-utilization-and-prescribing-patterns-in-living-kidney-donors/. Accessed November 21, 2024.« Back to 2020 American Transplant Congress