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Impact of Pre-operative Opioid Use on Racial Disparities in Adverse Outcomes Post Total Knee and Hip Arthroplasty

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Abstract

Introduction

The growing opioid epidemic in the USA has underlying racial disparities dimensions. Also, studies have shown that patients from minority racial groups are at higher risk of adverse events following major orthopedic surgery. The aim of our study was to determine whether pre-operative opioid-use disorders (OUDs) impacted racial disparities in the likelihood of patients experiencing adverse post-operative outcomes following TKA and THA.

Methods

Data about patients undergoing TKA and THA were collected from the 2005–2014 National Inpatient Sample databases. Regression modeling was used to assess the impact of OUDs on odds of adverse outcomes comparing racial groups. The adverse outcomes included any in-hospital post-surgical complications, prolonged length of stay (LOS), and nonhome discharge.

Results

In our fully adjusted regression models using White patients as the reference group, we found that OUDs were associated with racial disparities in prolonged LOS and nonhome discharge. In the non-OUD group, Black patients had significantly higher odds of longer LOS (OR: 1.35, 95% CI: 1.26–1.46, p-value: < 0.0001), whereas those with history of OUD had non-significantly lower odds of longer LOS (OR: 0.94, 95% CI: 0.69–1.29, p-value: 0.71). Similarly, for the outcome of nonhome discharges, Black patients in the non-OUD group had significantly higher odds (OR: 1.31, 95% CI: 1.21–1.43, p-value: < 0.0001) and those with a history of OUD had non-significantly lower odds (OR: 0.91, 95% CI: 0.64–1.29, p-value: 0.59).

Conclusions

Significant racial disparities are present in adverse events among patients in the non-OUD group, but those disparities attenuated in the OUD group.

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Acknowledgements

We thank Yihe Huang at the Milken Institute School of Public Health (The George Washington University) for his expertise and assistance while obtaining the HCUP NIS datasets used for analysis in this study.

Funding

This study was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD013901.

Author information

Authors and Affiliations

  1. Syapse Inc., San Francisco, CA, USA

    Hina Mohammed

  2. Milken Institute School of Public Health, The George Washington University, Washington, DC, USA

    Hina Mohammed & Manya Magnus

  3. Hospital for Special Surgery, New York City, NY, USA

    Michael Parks

  4. Weill Cornell Medical College, Cornell University, New York City, NY, USA

    Michael Parks

  5. Donal and Barbara Zucker School of Medicine, Northwell Health/ Hofstra University, Long Island, NY, USA

    Said Ibrahim

  6. Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Yan Ma

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Corresponding author

Correspondence to Yan Ma.

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Ethical Approval

Because the HCUP-NIS database includes only de-identified patient data, this study was deemed exempt by the George Washington University Committee on Human Research, Institutional Review Boards (IRB# NCR191817).

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Due to all the material consisting of secondary data, no consent was necessary.

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Due to secondary data utilization, informed consent was not required in this study.

Conflict of Interest

The authors (HM, MP, MM, YM) were supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD013901. The author (MP) received funding from Zimmer Biomet.

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Mohammed, H., Parks, M., Ibrahim, S. et al. Impact of Pre-operative Opioid Use on Racial Disparities in Adverse Outcomes Post Total Knee and Hip Arthroplasty. J. Racial and Ethnic Health Disparities 10, 3051–3061 (2023). https://doi.org/10.1007/s40615-022-01479-0

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