Racial Disparities in Analgesic Prescribing for Post-Surgical Pain Management among Older Americans following Hip and Knee Replacement Surgeries

摘要 与白色患者相比，黑人患者不太可能使用阿片类或非阿片类镇痛药来缓解疼痛 疼痛强度相似的患者，尤其是在急诊室。这些差异中有许多 是由医生的处方行为造成的。然而，在阿片类药物和非阿片类药物中是否存在类似的差异， 阿片类镇痛药处方为术后疼痛的老年美国人以下一个最常见的 对于他们的年龄选择性手术-髋关节和膝关节置换（“关节置换”）-是未知的。联合 置换术对于患有晚期骨关节炎的老年医疗保险受益人来说是非常成功的手术。 这些手术能够缓解疼痛，改善功能和健康相关的质量， 生活使他们成为老年医疗保险受益人最大的手术量。阿片类和非阿片类药物 阿片类镇痛药是两组常用于缓解关节术后疼痛的药物。 替代品阿片类药物以前是短期术后疼痛控制的首选药物。 然而，随着阿片类药物危机的破坏性影响，人们越来越认识到 最大限度地减少术后阿片类药物处方的持续时间，并增加非阿片类镇痛药的使用。 重要的是，这些药物的处方量和持续时间存在相当大的差异。这 变异性与处方者偏见相结合，可能会为黑人医疗保险受益人创造障碍， 获得急需的术后疼痛护理，并代表大量未满足的疼痛管理 这些患者的需求。这些未得到满足的需求进一步加剧了术后恢复方面的差距， 导致关节置换护理的不公平。此外，限制处方的州法律 如果阿片类药物处方的减少， 没有伴随非阿片类镇痛药处方的相应增加。我们提案的目的是 产生严格的经验证据，以支持公平的术后镇痛处方。我们实现 通过检查患者的种族是否影响阿片类和非阿片类镇痛药处方来实现这一目标 关节置换手术后（目标1），以及国家阿片类药物处方限制是否可能 影响这些差异（目标2）。我们将重点分析纽约正在经历 从2014年到2019年的关节置换。我们将使用医疗保险数据集和复杂的经验方法， 提出的目标。我们提案的结果将为改善后社会的公平提供证据。 手术镇痛处方的关节置换患者在全国各地和设计 干预措施可以减少手术疼痛管理中的种族差异。

ABSTRACT Black patients are less likely to be prescribed opioid or non-opioid analgesics for pain relief than White patients who present with similar pain intensities, especially in the emergency room. Many of these disparities are attributed to physician prescribing practices. However, whether similar disparities exist in opioid and non- opioid analgesic prescribing for post-operative pain for older Americans following one of the most common elective surgeries for their age – hip and knee replacements (“joint replacements”) – is unknown. Joint replacements are highly successful surgeries for older Medicare beneficiaries with advanced osteoarthritis. The ability of these surgeries to provide relief from pain, and improve functionality and health-related quality of life has placed them among the highest-volume surgeries for older Medicare beneficiaries. Opioid and non- opioid analgesics are the two groups of drugs commonly used to relieve surgical pain following joint replacements. Opioids were previously the first choice of drugs for short-term post-operative pain control. However, with the devastating implications of the opioid crisis, there is a growing recognition of the importance of minimizing the duration of post-operative opioid prescribing and increasing the use of non-opioid analgesics. Importantly, there is considerable variation in the prescribing amounts and duration of these drugs. This variability when coupled with prescriber biases, may create barriers for Black Medicare beneficiaries while accessing much-needed care for post-operative pain, and represents substantial unmet pain management needs for these patients. These unmet needs further exacerbate the disparities in post-operative recovery and contribute to the inequity in joint replacement care. Furthermore, state laws that restrict the prescribing of opioids for acute pain have the potential to exacerbate these disparities if the decline in opioid prescribing is not accompanied by a commensurate increase in non-opioid analgesic prescribing. The goal of our proposal is to generate rigorous empirical evidence to support equitable post-operative analgesic prescribing. We achieve this goal by examining whether a patient’s race influences opioid and non-opioid analgesic prescribing following joint replacement surgeries (Aim 1), and whether state opioid prescribing restrictions are likely to influence these disparities (Aim 2). We focus our analysis on Medicare beneficiaries in New York undergoing joint replacements from 2014-2019. We will use Medicare datasets and sophisticated empirical methods to address the proposed Aims. The findings from our proposal will generate evidence for improving equity in post- operative analgesic prescribing for joint replacement patients across the country and for the design of interventions that can attenuate racial disparities in surgical pain management.