Abstract
Background: Profound racial and ethnic disparities exist in the use and outcomes of total hip/knee replacements (total joint replacements [TJR]). Whether similar disparities extend to post-TJR pain management remains unknown. Our objective is to examine the association of race and ethnicity with opioid fills following elective TJRs for White, Black, and Hispanic Medicare beneficiaries. Methods: We used the 2019 national Medicare data to identify beneficiaries who underwent total hip/knee replacements. Primary outcomes were at least one opioid fill in the period from discharge to 30 days post-discharge, and 31–90 days following discharge. Secondary outcomes were morphine milligram equivalent per day and number of opioid fills. Key independent variable was patient race-ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic). We estimated multivariable hierarchical logistic regressions and two-part models with state-level clustering. Results: Among 67,550 patients, 93.36% were White, 3.69% were Black, and 2.95% were Hispanic. Compared to White patients, more Black patients and fewer Hispanic patients filled an opioid script (84.10% [Black] and 80.11% [Hispanic] vs. 80.33% [White], p < 0.001) in the 30-day period. On multivariable analysis, Black patients had 18% higher odds of filling an opioid script in the 30-day period (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 1.05–1.33, p = 0.004), and 39% higher odds in the 31–90-day period (OR: 1.39, 95% CI: 1.26–1.54, p < 0.001). There were no significant differences in the endpoints between Hispanic and White patients in the 30-day period. However, Hispanic patients had 20% higher odds of filling an opioid script in the 31- to 90-day period (OR: 1.20, 95% CI: 1.07–1.34, p = 0.002). Conclusions: Important race- and ethnicity-based differences exist in post-TJR pain management with opioids. The mechanisms leading to the higher use of opioids by racial/ethnic minority patients need to be carefully examined.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 102-112 |
| Number of pages | 11 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 72 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2024 |
Funding
Dr. Thirukumaran reports receiving speaker honoraria from the National Institutes of Health, Brown University, and Boston University; reviewer honoraria from the National Institutes of Health and the Veterans Affairs; and serves as the Disparities Section Editor for Current Osteoporosis Reports, and Anesthesia and Analgesia. Dr. Doshi is a paid consultant for Abbvie/Allergan, Acadia, Janssen, Merck, Otsuka, and Takeda; and reports research support from Janssen, Merck, Regeneron, and Spark Therapeutics. Dr. Schloemann reports research support from the University of Rochester and the American Foundation for Surgery of the Hand. Dr. Ricciardi reports research funding from Ethicon (Johnson and Johnson) and editorial board membership from Clinical Orthopedics and related research, The Knee, HSS Journal, and Arthroplasty Today. The authors gratefully acknowledge funding support from the National Institute on Aging under Award Number R21AG078552. Dr. Thirukumaran reports receiving speaker honoraria from the National Institutes of Health, Brown University and Boston University; reviewer honoraria from the National Institutes of Health and the Veterans Affairs; and serves as the Disparities Section Editor for Current Osteoporosis Reports, and Anesthesia and Analgesia. Dr. Doshi is a paid consultant for Abbvie/Allergan, Acadia, Janssen, Merck, Otsuka, Takeda; and reports research support from Janssen, Merck, Regeneron, Spark Therapeutics. Dr. Schloemann reports research support from the University of Rochester and the American Foundation for Surgery of the Hand. Dr. Ricciardi reports research funding from Ethicon (Johnson and Johnson) and editorial board membership from Clinical Orthopaedics and related research, The Knee, HSS Journal, and Arthroplasty Today.
Keywords
- joint replacements
- Medicare
- opioids
ASJC Scopus subject areas
- Geriatrics and Gerontology