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

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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.