2015 APHA Annual Meeting & Expo

Home Events & Meetings Annual Meeting Schedule & Program

Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

332519
Opioid Sparing Pain Protocol Reduces Adverse Events for Living Donor Liver Transplant Donors


Monday, November 2, 2015 : 3:10 p.m. - 3:30 p.m.

Donna Woods, PhD, EdM, Center for Healthcare Studies, Northwestern University, Chicago, IL
Elizabeth Pomfret, MD, Lahey Clinic, Burlington, MA
Mary Ann Simpson, PhD, Lahey Clinic, Burlington, MA
James Guarrera, MD, Columbia University Medical System, New York, NY
Robert Fischer, MD, FACS, Virginia Commonwealth University Medical Center, Richmond, IL
Timothy Curtis, BSN, RN, CEN, Center for Healthcare Studies, Northwestern University, Chicago, IL
Amna Daud, MD, MPH, Center for Healthcare Studies, Northwestern University, Chicago, IL
Ella Reyes, Center for Healthcare Studies, Northwestern University, Chicago, IL
Erin Wymore, MS, Center for Healthcare Studies, Northwestern University, Chicago, IL
Raymond Kang, M.A in Economics, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine
Daniela Ladner, MD, MPH, Center for Healthcare Studies, Northwestern University, Chicago, IL
  
Audio (mp3) recording Recorded Presentation (mp4)
Background: As part of a four-center, ancillary study to the Adult-to-Adult Living Donor Liver Transplant Cohort Study, living liver-donors were found to experience substantial post-operative pain.  Additionally, more than half the donors experienced complications associated with standard of care (SOC) pain management. Consequently, a multi-center, multi-disciplinary group of experts (anesthesiologists, transplant surgeons, pain and safety experts) developed a multimodal opioid-sparing post-operative donor pain protocol.

Methods: The opioid-sparing pain protocol was implemented at four large transplant centers, starting 2/2014. The protocol includes steroids, ketorolac, Cox 2 inhibitor, as well as opioids. A trained research nurse reviewed the donor medical records to assess post-operative pain scores and related complications, prior to (PRE) and after implementation of the new protocol (POST). PRE and POST data were compared. All centers obtained IRB approval.

Results: Ninety donors received SOC (PRE), and 32 donors received the opioid-sparing pain protocol (POST). In the PRE data, the most frequent opioid-related complications were nausea (60%), hypoxia (55%), constipation (47%) and hypotension (46%). All opioid-related complications diminished from PRE to POST (Table 1). Despite the small POST sample size, hypotension, hypoxia, and tachycardia were significantly reduced and constipation is showing a trend. Post-operative day 1 pain scores were significantly reduced, while pain scores for other days were similar PRE and POST.

Conclusions: Opioid-sparing donor pain protocol effectively reduced the high rate of opioid-related complications without worsening pain perception. There were no new complications associated with the pain protocol, demonstrating improved safety of the opioid-sparing donor pain protocol over present SOC. 

Complications

Cause

PRE
(N=90)

POST-Full Protocol
(N=32)

Percent Change
PRE-POST

p-Value

Tachycardia

Pain

24

(27%)

3

(9%)

-97%

0.036*

Hypoxia

Opioid

50

(55%)

11

(34%)

-89%

0.045*

Constipation

Opioid

42

(47%)

9

(28%)

-91%

0.060**

Hypotension

Opioid

41

(46%)

4

(13%)

-96%

0.001*

Dizziness

Opioid

13

(14%)

2

(6%)

-98%

0.232

Bradycardia

Opioid

8

(9%)

4

(13%)

-96%

0.543

Urinary Retention

Opioid

14

(15%)

4

(13%)

-96%

0.691

Vomiting

Opioid

13

(14%)

5

(16%)

-95%

0.854

Hyperglycemia

Steroids

14

(16%)

6

(19%)

-94%

0.770

Pruritis

Opioid

19

(21%)

7

(22%)

-93%

0.906

Tachypnea

Pain

32

(36%)

10

(31%)

-90%

0.609

Hypertension

Pain

23

(26%)

10

(31%)

-90%

0.596

Bradypnea

Opioid

35

(39%)

12

(38%)

-88%

0.923

Nausea

Opioid

54

(60%)

17

(53%)

-83%

0.470

Learning Areas:

Administer health education strategies, interventions and programs
Clinical medicine applied in public health

Learning Objectives:
List the preventable adverse events related to solely using opioids for post-operative pain Describe the reduction in preventable adverse events from implementation of an opioid-sparing post-operative pain protocol

Keyword(s): Quality Improvement, Physicians

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the PI and Co-I of many federal and foundation funded investigations focused on the considerable public health problems of patient safety and healthcare quality.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3377.0: Opioids Utilization in the US