Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Clin Orthop Relat Res. 2023 Aug 1;481(8):1504-1511. doi: 10.1097/CORR.0000000000002596. Epub 2023 Feb 16.
Previous studies have demonstrated racial disparities in opioid prescribing in emergency departments and after surgical procedures. Orthopaedic surgeons account for a large proportion of dispensed opioid prescriptions, yet there are few data investigating whether racial or ethnic disparities exist in opioid dispensing after orthopaedic procedures.
QUESTIONS/PURPOSES: (1) Are Black, Hispanic or Latino, or Asian or Pacific Islander (PI) patients less likely than non-Hispanic White patients to receive an opioid prescription after an orthopaedic procedure in an academic United States health system? (2) Of the patients who do receive a postoperative opioid prescription, do Black, Hispanic or Latino, or Asian or PI patients receive a lower analgesic dose than non-Hispanic White patients when analyzed by type of procedure performed?
Between January 2017 and March 2021, 60,782 patients underwent an orthopaedic surgical procedure at one of the six Penn Medicine healthcare system hospitals. Of these patients, we considered patients who had not been prescribed an opioid within 1 year eligible for the study, resulting in 61% (36,854) of patients. A total of 40% (24,106) of patients were excluded because they did not undergo one of the top eight most-common orthopaedic procedures studied or their procedure was not performed by a Penn Medicine faculty member. Missing data consisted of 382 patients who had no race or ethnicity listed in their record or declined to provide a race or ethnicity; these patients were excluded. This left 12,366 patients for analysis. Sixty-five percent (8076) of patients identified as non-Hispanic White, 27% (3289) identified as Black, 3% (372) identified as Hispanic or Latino, 3% (318) identified as Asian or PI, and 3% (311) identified as another race ("other"). Prescription dosages were converted to total morphine milligram equivalents for analysis. Statistical differences in receipt of a postoperative opioid prescription were assessed with multivariate logistic regression models within procedure, adjusted for age, gender, and type of healthcare insurance. Kruskal-Wallis tests were used to assess for differences in the total morphine milligram equivalent dosage of the prescription, stratified by procedure.
Almost all patients (95% [11,770 of 12,366]) received an opioid prescription. After risk adjustment, we found no differences in the odds of Black (odds ratio 0.94 [95% confidence interval 0.78 to 1.15]; p = 0.68), Hispanic or Latino (OR 0.75 [95% CI 0.47 to 1.20]; p = 0.18), Asian or PI (OR 1.00 [95% CI 0.58 to 1.74]; p = 0.96), or other-race patients (OR 1.33 [95% CI 0.72 to 2.47]; p = 0.26) receiving a postoperative opioid prescription compared with non-Hispanic White patients. There were no race or ethnicity differences in the median morphine milligram equivalent dose of postoperative opioid analgesics prescribed (p > 0.1 for all eight procedures) based on procedure.
In this academic health system, we did not find any differences in opioid prescribing after common orthopaedic procedures by patient race or ethnicity. A potential explanation is the use of surgical pathways in our orthopaedic department. Formal standardized opioid prescribing guidelines may reduce variability in opioid prescribing.
Level III, therapeutic study.
先前的研究表明，在急诊室和手术后，阿片类药物的处方存在种族差异。骨科医生开具了大量的阿片类药物处方，但关于骨科手术后是否存在阿片类药物开具的种族或民族差异的数据很少。
问题/目的：(1) 在一个美国学术医疗系统中，与非西班牙裔白人患者相比，黑人、西班牙裔或拉丁裔、或亚洲或太平洋岛民（PI）患者在骨科手术后接受阿片类药物处方的可能性是否更小？(2) 在接受术后阿片类药物处方的患者中，当按手术类型分析时，黑人、西班牙裔或拉丁裔、或亚洲或 PI 患者的阿片类药物镇痛剂量是否低于非西班牙裔白人患者？
在 2017 年 1 月至 2021 年 3 月期间，60782 名患者在宾夕法尼亚大学医疗系统的六家医院之一接受了骨科手术。在这些患者中，我们考虑了在 1 年内未开具阿片类药物处方的患者符合研究条件，这导致 61%（36854 人）的患者被纳入。共有 40%（24106 人）的患者因未接受研究中最常见的前 8 种骨科手术之一或其手术不是由宾夕法尼亚大学医学系教员进行而被排除在外。缺失数据包括 382 名患者，他们的记录中没有列出种族或族裔，或者拒绝提供种族或族裔；这些患者被排除在外。这留下了 12366 名患者进行分析。65%（8076 人）的患者被认定为非西班牙裔白人，27%（3289 人）被认定为黑人，3%（372 人）被认定为西班牙裔或拉丁裔，3%（318 人）被认定为亚洲或 PI，3%（311 人）被认定为其他种族（“其他”）。为了分析，将处方剂量转换为总吗啡毫克当量。在程序内，使用多变量逻辑回归模型评估接受术后阿片类药物处方的差异，并调整年龄、性别和医疗保险类型。使用 Kruskal-Wallis 检验评估按程序分层的处方总吗啡毫克当量剂量的差异。
几乎所有患者（95%[11770/12366]）都收到了阿片类药物处方。在风险调整后，我们发现黑人（优势比 0.94[95%置信区间 0.78 至 1.15]；p=0.68）、西班牙裔或拉丁裔（OR 0.75[95%CI 0.47 至 1.20]；p=0.18）、亚洲或 PI（OR 1.00[95%CI 0.58 至 1.74]；p=0.96）或其他种族（OR 1.33[95%CI 0.72 至 2.47]；p=0.26）患者接受术后阿片类药物处方的可能性与非西班牙裔白人患者相比没有差异。根据手术类型，接受术后阿片类药物镇痛的中位数吗啡毫克当量剂量在种族或族裔方面没有差异（所有八项手术的 p 值均大于 0.1）。
在这个学术医疗系统中，我们没有发现骨科常见手术后阿片类药物处方与患者种族或族裔有关。一种可能的解释是我们骨科部门使用了手术途径。正式的标准化阿片类药物处方指南可能会减少阿片类药物处方的变异性。
三级，治疗性研究。
