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

美国老年人髋关节和膝关节置换手术后术后疼痛管理镇痛处方的种族差异

• 批准号: 10693957
• 负责人: Caroline Pinto Thirukumaran
• 金额: $ 19.47万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693957
• 关键词: Accident and Emergency department; Acute Pain; Address; Adverse effects; Adverse event; Age; American; Analgesics; Attenuated; Belief; Biological; Black race; Caring; Country; Coupled; Data; Data Set; Degenerative polyarthritis; Disparity; Dose; Drug Prescriptions; Elderly; Emergency department visit; Empathy; Equity; Event; Future; Goals; Grant; Healthcare; Income; Inequity; Inpatients; Intervention; Laws; Lead; Measures; Mediating; Medicaid eligibility; Medicare; Methods; New York; Operative Surgical Procedures; Opioid; Opioid Analgesics; Pain; Pain management; Patients; Pharmaceutical Preparations; Physicians; Postoperative Care; Postoperative Pain; Postoperative Period; Predisposition; Provider; Race; Replacement Arthroplasty; Reporting; Risk; Role; Series; Statutes and Laws; Therapeutic; Total Hip Replacement; Variant; beneficiary; black patient; design; dual eligible; econometrics; gastrointestinal; health care service utilization; health related quality of life; hip replacement arthroplasty; hospital readmission; improved; interest; knee replacement arthroplasty; non-opioid analgesic; opioid epidemic; pain relief; postoperative recovery; prescription opioid; racial disparity; respiratory; response; surgery outcome; surgical pain; therapy design; treatment group

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.

抽象的 与白人相比，黑人患者不太可能服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，尤其是在急诊室的患者。其中许多差异 归因于医生的处方实践。然而，阿片类药物和非药物是否也存在类似的差异？ 阿片类镇痛药用于治疗美国老年人术后疼痛，最常见的原因之一是 适合他们年龄的选择性手术——髋关节和膝关节置换术（“关节置换术”）——尚不清楚。联合的 对于患有晚期骨关节炎的老年医疗保险受益人来说，替代手术是非常成功的手术。 这些手术能够缓解疼痛并改善患者的功能和健康相关质量 生活使它们成为老年医疗保险受益人接受手术量最大的手术之一。阿片类药物和非 阿片类镇痛药是两类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，人们越来越认识到阿片类药物的重要性 尽量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很大差异。这 变异性与处方者偏见相结合，可能会给黑人医疗保险受益人造成障碍，而 获得急需的术后疼痛护理，并且代表着大量未得到满足的疼痛管理 这些患者的需求。这些未满足的需求进一步加剧了术后恢复和康复方面的差距。 造成关节置换护理的不平等。此外，州法律限制开药 如果阿片类药物处方量减少，用于治疗急性疼痛的阿片类药物有可能加剧这些差异 不伴随非阿片类镇痛药处方的相应增加。我们提案的目标是 产生严格的经验证据来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药物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）。我们的分析重点是纽约的医疗保险受益人 2014 年至 2019 年进行关节置换手术。我们将使用医疗保险数据集和复杂的经验方法来 解决拟议的目标。我们提案的调查结果将为改善后公平性提供证据 全国关节置换患者的手术镇痛处方和设计 可以减少手术疼痛管理中种族差异的干预措施。

项目成果

Association of race and ethnicity with opioid prescribing for Medicare beneficiaries following total joint replacements.

种族和民族与全关节置换术后医疗保险受益人阿片类药物处方的关系。

• DOI: 10.1111/jgs.18605
• 发表时间: 2024
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Thirukumaran,CarolineP;Fiscella,KevinA;Rosenthal,MeredithB;Doshi,JalpaA;Schloemann,DerekT;Ricciardi,BenjaminF
• 通讯作者: Ricciardi,BenjaminF

What Factors Are Associated With Revision Cubital Tunnel Release Within 3 Years?

三年内修订肘形隧道释放与哪些因素相关？

• DOI: 10.1097/corr.0000000000002629
• 发表时间: 2023
• 期刊: Clinical orthopaedics and related research
• 影响因子: 4.2
• 作者: Schloemann,DerekT;Hammert,WarrenC;Mandalapu,Aniruddh;Thirukumaran,CarolineP
• 通讯作者: Thirukumaran,CarolineP

Association of Total Knee Replacement Removal From the Inpatient-Only List With Outpatient Surgery Utilization and Outcomes in Medicare Patients.

• DOI: 10.1001/jamanetworkopen.2023.16769
• 发表时间: 2023-06-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Schloemann, Derek T.;Sajda, Thomas;Ricciardi, Benjamin F.;Thirukumaran, Caroline P.
• 通讯作者: Thirukumaran, Caroline P.