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

摘要 黑人患者比白人患者更少被开阿片类或非阿片类止痛药用于止痛 疼痛强度相似的患者，尤其是在急诊室。这些差距中的许多 归因于医生开处方的做法。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 阿片类止痛药用于美国老年人术后疼痛的处方是最常见的之一 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”)--是未知的。接合 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。 这些手术提供疼痛缓解的能力，并改善功能和与健康相关的质量 生活使他们成为老年医疗保险受益人数量最大的手术之一。阿片类和非阿片类 阿片类止痛药是通常用于缓解关节手术后疼痛的两类药物。 接班人。阿片类药物以前是手术后短期止痛的首选药物。 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 减少术后阿片类药物处方的持续时间，增加非阿片类镇痛剂的使用。 重要的是，这些药物的处方数量和持续时间有相当大的差异。这 当变异性加上处方偏见时，可能会为黑人医疗保险受益人造成障碍，而 获得手术后疼痛急需的护理，代表着大量未得到满足的疼痛管理 对这些病人的需求。这些未得到满足的需求进一步加剧了术后恢复和 造成关节置换护理的不公平。此外，限制开处方的州法律 治疗急性疼痛的阿片类药物有可能加剧这些差异，如果阿片类药物处方的下降 没有伴随着非阿片类止痛药处方的相应增加。我们提案的目标是 提供严格的经验证据，以支持公平的术后止痛药处方。我们实现了 通过检查患者的种族是否影响阿片类和非阿片类止痛药的处方来实现这一目标 在关节置换手术后(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联邦医疗保险受益人正在经历的 2014-2019年的联合更替。我们将使用医疗保险数据集和复杂的经验方法来 解决提议的目标。我们提案的调查结果将为改善岗位公平提供证据。 全国关节置换术患者手术止痛处方的设计 可以缩小手术疼痛管理中的种族差异的干预措施。

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.