{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T01:31:47Z","timestamp":1789090307254,"version":"build-2803163510"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec id=\"ab-soi230009-4\"><jats:title>Importance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230009-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the long-term outcomes associated with an opioid minimization protocol following kidney transplant.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230009-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230009-7\"><jats:title>Exposures<\/jats:title><jats:p>Preprotocol and postprotocol implementation use of opioids.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230009-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230009-9\"><jats:title>Results<\/jats:title><jats:p>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; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). 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; <jats:italic>P<\/jats:italic>\u2009=\u2009.04).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi230009-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The study\u2019s findings show a significant reduction in opioid use in kidney graft recipients associated with the implementation of a multimodal opioid-sparing pain protocol.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2023.0276","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T15:06:41Z","timestamp":1680707201000},"page":"618","source":"Crossref","is-referenced-by-count":11,"title":["Long-term Outcomes Following a Comprehensive Quality Assurance and Process Improvement Endeavor to Minimize Opioid Use After Kidney 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