Associate Professor University of Pittsburgh School of Medicine Pittsburgh, PA, US
Introduction: As the opioid epidemic accelerates in the United States, the CDC estimates there were over 100,000 drug-related overdose deaths in 2021. Numerous sociodemographic factors have been implicated in the development of the opioid epidemic and are furthermore a driving factor of the disparities in postoperative pain management. Recent studies have suggested potential associations between the influence of race and ethnicity on pain perception, but also the presence of unconscious biases in the treatment of pain in minority patients. Given the current lack of evidence, the purpose of this study was to characterize the perioperative opioid requirements across racial groups following spine surgery.
Methods: A retrospective, observational study of 1,944 opioid-naïve adult patients undergoing a spinal neurosurgical intervention from June 2012 to December 2019 was performed at a large, quaternary care institute. Oral morphine equivalents (OMEs) allow for the standardized measure of opioid use. This study focused on the postoperative inpatient and outpatient opioid usage, as measured by OMEs, across various racial groups.
Results: 1,944 opioid-naïve neurosurgical spine patients were included in the study cohort. Case characteristics were similar between racial groups. In the postoperative period, White patients had shorter lengths of stay compared to Black and Asian patients (p < 0.05). Asian patients used lower postoperative inpatient opioid doses in comparison to White patients (p < 0.001). White patients were discharged with significantly higher doses of opioids compared to Black patients (p < 0.01), however, were less likely to be readmitted within 30 days of discharge (p < 0.01).
Conclusion : In a large cohort of opioid-naïve postoperative neurosurgical spine patients, this study demonstrates higher inpatient and outpatient postoperative opioid usage among White patients. Increasing physician awareness to individual postoperative opioid needs allows for a tailored opioid prescribing strategy that ensures limited, yet effective opioid dosages.
