Association of Race and Ethnicity With Postoperative Gabapentinoid and Opioid Prescribing Trends for Older Adults

Tasce Bongiovanni; Siqi Gan; Emily Finlayson; Joseph S Ross; James D Harrison; W John Boscardin; Michael A Steinman

doi:10.1016/j.jss.2024.02.017

Association of Race and Ethnicity With Postoperative Gabapentinoid and Opioid Prescribing Trends for Older Adults

J Surg Res. 2024 Mar 29:298:47-52. doi: 10.1016/j.jss.2024.02.017. Online ahead of print.

Authors

Tasce Bongiovanni¹, Siqi Gan², Emily Finlayson³, Joseph S Ross⁴, James D Harrison⁵, W John Boscardin⁶, Michael A Steinman⁷

Affiliations

¹ Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California. Electronic address: tasce.bongiovanni@ucsf.edu.
² Division of Geriatrics, University of California San Francisco School of Medicine, San Francisco, California; Northern California Institute for Research and Education, San Francisco, California.
³ Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California.
⁴ Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut.
⁵ Division of Hospital Medicine, University of California San Francisco School of Medicine, San Francisco, California.
⁶ Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California.
⁷ Division of Geriatrics, University of California San Francisco School of Medicine, San Francisco, California; San Francisco VA Medical Center, San Francisco, California.

PMID: 38554545
DOI: 10.1016/j.jss.2024.02.017

Abstract

Background: Disparities in opioid prescribing by race/ethnicity have been described in many healthcare settings, with White patients being more likely to receive an opioid prescription than other races studied. As surgeons increase prescribing of nonopioid medications in response to the opioid epidemic, it is unknown whether postoperative prescribing disparities also exist for these medications, specifically gabapentinoids.

Methods: We conducted a retrospective cohort study using a 20% Medicare sample for 2013-2018. We included patients ≥66 years without prior gabapentinoid use who underwent one of 14 common surgical procedures. The primary outcome was the proportion of patients prescribed gabapentinoids at discharge among racial and ethnic groups. Secondary outcomes were days' supply of gabapentinoids, opioid prescribing at discharge, and oral morphine equivalent (OME) of opioid prescriptions. Trends over time were constructed by analyzing proportion of postoperative prescribing of gabapentinoids and opioids for each year. For trends by year by racial/ethnic groups, we ran a multivariable logistic regression with an interaction term of procedure year and racial/ethnic group.

Results: Of the 494,922 patients in the cohort (54% female, 86% White, 5% Black, 5% Hispanic, mean age 73.7 years), 3.7% received a new gabapentinoid prescription. Gabapentinoid prescribing increased over time for all groups and did not differ significantly among groups (P = 0.13). Opioid prescribing also increased, with higher proportion of prescribing to White patients than to Black and Hispanic patients in every year except 2014.

Conclusions: We found no significant prescribing variation of gabapentinoids in the postoperative period between racial/ethnic groups. Importantly, we found that despite national attention to disparities in opioid prescribing, variation continues to persist in postoperative opioid prescribing, with a higher proportion of White patients being prescribed opioids, a difference that persisted over time.

Keywords: Disparities; Gabapentinoids; Older adults; Opioids; Postoperative pain; Race.