Department of Pharmacy, Medical University of South Carolina, Charleston.
College of Medicine, Medical University of South Carolina, Charleston.
JAMA Surg. 2023 Jun 1;158(6):618-624. doi: 10.1001/jamasurg.2023.0276.
Opioid use following kidney transplant is associated with an increased risk of graft loss and mortality. Opioid minimization strategies and protocols have shown reductions in short-term opioid use after kidney transplant.
To evaluate the long-term outcomes associated with an opioid minimization protocol following kidney transplant.
DESIGN, SETTING, AND PARTICIPANTS: This single-center quality improvement study evaluated postoperative and long-term opioid use before and after the implementation of a multidisciplinary, multimodal pain regimen and education process in adult kidney graft recipients from August 1, 2017, through June 30, 2020. Patient data were collected from a retrospective chart review.
Preprotocol and postprotocol implementation use of opioids.
Between November 7 and 23, 2022, opioid use before and after protocol implementation was evaluated up to 1 year after transplant using multivariable linear and logistic regression.
A total of 743 patients were included, with 245 patients in the preprotocol group (39.2% female and 60.8% male; mean [SD] age, 52.8 [13.1 years]) vs 498 in the postprotocol group (45.4% female and 54.6% male; mean [SD] age, 52.4 [12.9 years]). The total morphine milligram equivalents (MME) in the 1-year follow-up in the preprotocol group was 1203.7 vs 581.9 in the postprotocol group. In the postprotocol group, 313 patients (62.9%) had 0 MME in the 1-year follow-up vs 7 (2.9%) in the preprotocol group (odds ratio [OR], 57.52; 95% CI, 26.55-124.65). Patients in the postprotocol group had 99% lower odds of filling more than 100 MME in the 1-year follow-up (adjusted OR, 0.01; 95% CI, 0.01-0.02; P < .001). Opioid-naive patients postprotocol were one-half as likely to become long-term opioid users vs preprotocol (OR, 0.44; 95% CI, 0.20-0.98; P = .04).
The study's findings show a significant reduction in opioid use in kidney graft recipients associated with the implementation of a multimodal opioid-sparing pain protocol.
肾移植后使用阿片类药物与移植物丢失和死亡风险增加有关。阿片类药物最小化策略和方案已显示出肾移植后短期阿片类药物使用减少。
评估肾移植后采用阿片类药物最小化方案的长期结果。
设计、地点和参与者：这项单中心质量改进研究评估了 2017 年 8 月 1 日至 2020 年 6 月 30 日期间，在接受成人肾移植的患者中实施多学科、多模式疼痛方案和教育过程前后，术后和长期阿片类药物使用情况。患者数据通过回顾性病历记录收集。
方案实施前后的阿片类药物使用情况。
在 2022 年 11 月 7 日至 23 日期间，使用多变量线性和逻辑回归评估了方案实施前后 1 年的阿片类药物使用情况，直至移植后 1 年。
共纳入 743 例患者，其中预方案组 245 例（女性占 39.2%，男性占 60.8%；平均[标准差]年龄为 52.8[13.1]岁），后方案组 498 例（女性占 45.4%，男性占 54.6%；平均[标准差]年龄为 52.4[12.9]岁）。预方案组在 1 年随访期间的总吗啡毫克当量（MME）为 1203.7，而后方案组为 581.9。在后方案组中，313 例（62.9%）患者在 1 年随访期间无 MME，而预方案组中只有 7 例（2.9%）（比值比[OR]，57.52；95%置信区间[CI]，26.55-124.65）。在后方案组中，1 年随访期间，患者使用 MME 超过 100 毫克的可能性降低了 99%（调整后的 OR，0.01；95%CI，0.01-0.02；P<0.001）。与预方案相比，阿片类药物初次使用者在后方案中成为长期阿片类药物使用者的可能性降低了一半（OR，0.44；95%CI，0.20-0.98；P=0.04）。
研究结果表明，在实施多模式阿片类药物节约疼痛方案后，肾移植受者的阿片类药物使用显著减少。
