Importance Prescription opioids play an important role in the treatment of post-operative pain, yet unused opioids may be diverted for non-medical use and contribute to opioid-related injuries and deaths. Objective To quantify how commonly post-operative opioids are unused, why they remain unused, and practices regarding their storage and disposal after surgery. Evidence Review We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 18 October 2016 for studies describing opioid over-supply for adults after any surgery or procedure. We defined our primary outcome, opioid over-supply, as the number of patients with either filled prescriptions with unused opioids or unfilled opioid prescriptions. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. Findings Six eligible studies reported on a total of 810 patients (range 30–250) undergoing seven different procedure types. Across the six studies, between two-thirds (67%) to nine-tenths (92%) of patients reported unused opioids. Among opioids obtained by surgical patients, 42% to 71% of all tablets went unused. A majority of patients stopped or used no opioids due to adequate pain control, while 16% to 29% of patients reported opioid-induced side effects. In two studies examining storage safety, 73% to 77% of patients reported that their prescription opioids were not stored in locked containers. All studies reported low rates of anticipated or actual disposal, while no study reported FDA-recommended disposal methods in more than 9% of patients. Conclusions & Relevance Post-operative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to non-medical use of these products.

Infections remain a major threat to successful kidney transplantation (KT). To characterize the landscape and impact of post-KT infections in the modern era, we used United States Renal Data System (USRDS) data linked to the Scientific Registry of Transplant Recipients (SRTR) to study 141 661 Medicare-primary kidney transplant recipients from January 1, 1999 to December 31, 2014. Infection diagnoses were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. The cumulative incidence of a post-KT infection was 36.9% at 3 months, 53.7% at 1 year, and 78.0% at 5 years. The most common infections were urinary tract infection (UTI; 46.8%) and pneumonia (28.2%). Five-year mortality for kidney transplant recipients

Steatotic donor livers (SDLs) (macrosteatosis ≥30%) represent a possible donor pool expansion, but are frequently discarded due to a historical association with mortality and graft loss. However, changes in recipient/donor demographics, allocation policy, and clinical protocols might have altered utilization and outcomes of SDLs. We used Scientific Registry of Transplant Recipients data from 2005 to 2017 and adjusted multilevel regression to quantify temporal trends in discard rates (logistic) and posttransplant outcomes (Cox) of SDLs, accounting for Organ Procurement Organization–level variation. Of 4346 recovered SDLs, 58.0% were discarded in 2005, versus only 43.1% in 2017 (P < .001). SDLs were always substantially more likely discarded versus non‐SDLs, although this difference decreased over time (adjusted odds ratio in 2005‐2007:13.1515.2817.74; 2008‐2011:11.7713.4115.29; 2012‐2014:9.8711.3713.10; 2015‐2017:7.798.8910.15, P < .001 for all). Conversely, posttransplant outcomes of recipients of SDLs improved over time: recipients of SDLs from 2012 to 2017 had 46% lower risk of mortality (adjusted hazard ratio [aHR]: 0.430.540.68, P < .001) and 47% lower risk of graft loss (aHR: 0.420.530.67, P < .001) compared to 2005 to 2011. In fact, in 2012 to 2017, recipients of SDLs had equivalent mortality (aHR: 0.901.041.21, P = .6) and graft loss (aHR: 0.901.041.20, P = .6) to recipients of non‐SDLs. Increasing utilization of SDLs might be a reasonable strategy to expand the donor pool.