David C Cron1,2, Monica A Tincopa1,3, Jay S Lee1,4, Akbar K Waljee1,3,5, Ali Hammoud4, Chad M Brummett1,6, Jennifer F Waljee1,4, Michael J Englesbe1,4, Christopher J Sonnenday1,4. 1. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. 2. Department of Surgery, Massachusetts General Hospital, Boston, MA. 3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI. 4. Department of Surgery, University of Michigan Medical School, Ann Arbor, MI. 5. Veteran's Affairs Center for Clinical Management Research, Ann Arbor, MI. 6. Division of Pain Research, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI.
Abstract
BACKGROUND: Opioid use in liver transplantation is poorly understood and has potential associated morbidity. METHODS: Using a national data set of employer-based insurance claims, we identified 1257 adults who underwent liver transplantation between December 2009 and February 2015. We categorized patients based on their duration of opioid fills over the year before and after transplant admission as opioid-naive/no fills, chronic opioid use (≥120 d supply), and intermittent use (all other use). We calculated risk-adjusted prevalence of peritransplant opioid fills, assessed changes in opioid use after transplant, and identified correlates of persistent or increased opioid use posttransplant. RESULTS: Overall, 45% of patients filled ≥1 opioid prescription in the year before transplant (35% intermittent use, 10% chronic). Posttransplant, 61% of patients filled an opioid prescription 0-2 months after discharge, and 21% filled an opioid between 10-12 months after discharge. Among previously opioid-naive patients, 4% developed chronic use posttransplant. Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant. Pretransplant opioid use (risk factor) and hepatobiliary malignancy (protective) were the only factors independently associated with risk of persistent or increased posttransplant opioid use. CONCLUSIONS: Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant. To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.
BACKGROUND: Opioid use in liver transplantation is poorly understood and has potential associated morbidity. METHODS: Using a national data set of employer-based insurance claims, we identified 1257 adults who underwent liver transplantation between December 2009 and February 2015. We categorized patients based on their duration of opioid fills over the year before and after transplant admission as opioid-naive/no fills, chronic opioid use (≥120 d supply), and intermittent use (all other use). We calculated risk-adjusted prevalence of peritransplant opioid fills, assessed changes in opioid use after transplant, and identified correlates of persistent or increased opioid use posttransplant. RESULTS: Overall, 45% of patients filled ≥1 opioid prescription in the year before transplant (35% intermittent use, 10% chronic). Posttransplant, 61% of patients filled an opioid prescription 0-2 months after discharge, and 21% filled an opioid between 10-12 months after discharge. Among previously opioid-naive patients, 4% developed chronic use posttransplant. Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant. Pretransplant opioid use (risk factor) and hepatobiliary malignancy (protective) were the only factors independently associated with risk of persistent or increased posttransplant opioid use. CONCLUSIONS: Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant. To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.
Authors: Chad M Brummett; Jennifer F Waljee; Jenna Goesling; Stephanie Moser; Paul Lin; Michael J Englesbe; Amy S B Bohnert; Sachin Kheterpal; Brahmajee K Nallamothu Journal: JAMA Surg Date: 2017-06-21 Impact factor: 14.766
Authors: Jennifer F Waljee; David C Cron; Rena M Steiger; Lin Zhong; Michael J Englesbe; Chad M Brummett Journal: Ann Surg Date: 2017-04 Impact factor: 12.969
Authors: Xueying Jiang; Margaret Orton; Rui Feng; Erik Hossain; Neil R Malhotra; Eric L Zager; Renyu Liu Journal: Ann Surg Date: 2017-04 Impact factor: 12.969
Authors: K L Lentine; N N Lam; A S Naik; D A Axelrod; Z Zhang; V R Dharnidharka; G P Hess; D L Segev; R Ouseph; H Randall; T Alhamad; R Devraj; R Gadi; B L Kasiske; D C Brennan; M A Schnitzler Journal: Am J Transplant Date: 2018-04-17 Impact factor: 8.086
Authors: Jay Soong-Jin Lee; Hsou Mei Hu; Anthony L Edelman; Chad M Brummett; Michael J Englesbe; Jennifer F Waljee; Jeffrey B Smerage; Jennifer J Griggs; Hari Nathan; Jacqueline S Jeruss; Lesly A Dossett Journal: J Clin Oncol Date: 2017-10-19 Impact factor: 44.544
Authors: Alok Madan; Kelly S Barth; Wendy E Balliet; Melba A Hernandez-Tejada; Jeffrey J Borckardt; Robert Malcolm; Ira Willner; David Koch; Adrian Reuben Journal: Prog Transplant Date: 2012-12 Impact factor: 1.187
Authors: Monica A Konerman; Mary Rogers; Brooke Kenney; Amit G Singal; Elliot Tapper; Pratima Sharma; Sameer Saini; Brahmajee Nallamothu; Akbar Waljee Journal: BMJ Open Gastroenterol Date: 2019-04-14