Variation in opioid prescribing patterns after abdominal transplant surgery

Background: Opioids are associated with negative transplant outcomes. We sought to identify patient and center effects on over-prescribing of opioids (> 200 OME (oral morphine equivalents)). Study design: Clinical and opioid prescription data (2014–2017) were collected from three academic transplant centers for kidney (KT), liver (LT), and simultaneous liver-kidney transplant (SLK) patients. Multivariable models were used to identify predictors of opioid over-prescribing at discharge and the occurrence of refill prescriptions at 90 days. Results: Three-thousand seven-hundred and two patients underwent transplant in the cohort (KT: n = 2358, LT: n = 1221, SLK: n = 123). More than 80% of recipients were over-prescribed opioids at discharge (Median OME (mOME) = 300 (IQR 225–375). LT and SLK had the largest prescription size (LT mOME 338 (IQR 300–450); SLK mOME 338 (IQR 225–450) and refill rate (LT: 64%, SLK 59%) (all, P <.001). Multivariable analysis indicated that transplant center was a significant predictor of opioid over-prescription after KT and LT (all, P <.001); older age (in KT) and length of stay (LOS) (in LT) were protective factors (both, P <.05). Refill occurrence was associated with initial prescription size and was reduced by older age and initial LOS (all, P <.05). Conclusions: The wide variation in opioid prescribing patterns has implications for transplant practice innovation, guideline development, and further study.