title: Association between opioid use and readmission following liver transplantation.
abstract: The aim of this study was to assess the independent association between pre-transplant prescription opioid use and readmission following liver transplantation. We reviewed the medical records of all patients at a single medical center undergoing primary, single-organ, liver transplantation from 2004 to 2014. We assessed factors associated with hospital readmission 30 days and 1 year after hospital discharge using multivariable competing risk regression models. Among 1056 transplant recipients, 49 (4.6%) were prescribed pre-transplant prescription opioids. Readmission occurred in 421 (40%) patients within 30 days and 689 (65%) within 1 year. Patients with pre-transplant opioid use had a significantly higher risk of readmission at 30 days (HR 1.7; 95% CI 1.1-2.5) and a non-significantly elevated risk at 1 year (HR 1.4; 95% CI 1.0-1.9) when controlling for other potential confounders. Although pain was the major reason for readmission in only 12 (3%) patients at 30 days and 33 (6%) patients at 1 year, pre-transplant opioid use was significantly associated with pain-related readmission at both time points. In conclusion, prescription opioid use pre-transplantation was significantly associated with all-cause 30-day readmissions and pain-related readmissions at 30 days and 1 year.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. rogalss@upmc.edu.|Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. rogalss@upmc.edu.|Division of Gastroenterology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. rogalss@upmc.edu.|Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. rogalss@upmc.edu.
authors.forename: Shari
authors.initials: S
authors.lastname: Rogal
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Gautham
authors.initials: G
authors.lastname: Mankaney
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Viyan
authors.initials: V
authors.lastname: Udawatta
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
authors.affiliation: VISN 4 Mental Illness Research and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chinman
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Zickmund
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Bielefeldt
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Naudia
authors.initials: N
authors.lastname: Jonassaint
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Jazwinski
authors.affiliation: Division of Gastroenterology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Obaid
authors.initials: O
authors.lastname: Shaikh
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hughes
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: DiMartini
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000139:chemically induced; D010359:Patient Readmission / Q000706:statistics & numerical data*; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid
keywords: narcotics; pain; rehabilitation; rehospitalization