Discrepancy in Opioid Prescription Patterns for Black or African American Patients Following Lower Extremity Bypass Surgery for Chronic Limb-Threatening Ischemia.

ABSTRACT

INTRODUCTION: Disparity in the allocation of medical services and resources based on race is present within the health care industry today including the prescription of postoperative analgesics. The purpose of this study was to evaluate the presence of race-based disparity in the prescription of post discharge opioids following lower extremity bypass (LEB) surgery for chronic limb-threatening ischemia (CLTI). METHODS: Retrospective analysis was conducted on adult CLTI patients who underwent LEB from 2000 to 2023 in the TrinetX database. Patients were stratified into two groups based on race White (Group I) and black or African American (Group II). Primary outcomes were defined as oral opioid prescriptions at 7 days and 30 days post discharge, and mortality at 1 year postoperatively. Secondary outcomes included length of stay (LOS) and 30-day postoperative outcomes including myocardial infarction (MI), pulmonary embolism (PE), cerebral vascular accident (CVA), deep vein thrombosis (DVT), acute kidney injury (AKI), major amputation, minor amputation, Major Adverse Cardiac Events (MACE), and Major Adverse Limb Events (MALE). Stratified analysis was conducted based on disease stage (rest pain vs lower extremity ulcer vs gangrene). Univariate analysis was performed via two-sample t-test and Chi-squared test. Logistic regression was performed to estimate the association of Black or AA (vs. White) race while controlling for pertinent preoperative potential confounders. RESULTS: 3,345 patients met inclusion criteria. Group I included 2,661 White patients and Group II included 684 Black or African American patients. Group II patients were more likely to be younger, female, present with gangrene, and have a history of hypertension, diabetes, chronic kidney disease, or diabetic neuropathy. At both seven- and thirty-days post discharge, the Black or AA cohort had significantly lower rates of opioid prescriptions (33.2% vs 42.5% and 35.8% vs 47.2%, respectively) (all p<0.05). Stratification by indication showed that opioid prescription disparity persisted despite black or AA patients presenting at worse stages of disease both at seven and thirty days post discharge (7-days Rest pain 43.4% vs. 33.7%, p=0.013, Ulcer 41.4% vs 31.7%, p=0.027, Gangrene, 42.7% vs 33.6%, p=0.006 & 30-days Rest pain 47.8% vs. 37.1%, p=0.007, Ulcer 45.4% vs 33.5%, p=0.007, Gangrene, 48.2% vs 36.1%, p<0.001). Adjusted analysis confirmed that Black or African American race was associated with lower rates of seven (AOR 0.607, p=0.001) and thirty-day (AOR 0.56, p=0.001) post discharge opioid prescriptions. CONCLUSION: Black or African American patients were less likely to receive post discharge opioid prescriptions compared with their white counterparts at seven- and 30-days following LEB for CLTI.