Racial and sex disparities in opioid administration under anesthesia

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Authors: Melat Gebre, Evesha K Kenlyn, David W Boorman, Addison Jones, Grant Lynde, and Anna Woodbury
Page Range: 55-65
Published in: Journal of Pain Management, 16#1 (2023)
ISSN: 1939-5914

Table of Contents

ABSTRACT

Patients 18 years of age and older who have undergone surgery under general anesthesia were evaluated to identify risk and protective factors that affect intraoperative opioid administration and post-operative care unit (PACU) length of stay (LOS). 103,778 patients were included from two Emory University hospitals from 1/1/2014 through 12/31/2018. Data was collected on 22 clinical variables, including: sex, age, body mass index (BMI), type of surgery, American Society of Anesthesiologists (ASA) physical status, home opioid use, opioid sparing medications, and regional/neuraxial anesthesia. Regressions were adjusted for clinical variables listed simultaneously. African American race was associated with less intraoperative opioids (37.5 MME) on average than Asians (47.5 MME), non-Hispanic Whites (50 MME), and “other” (47.2 MME) p < 0.0001. Female sex was correlated with more intraoperative opioids on average (45 MME) than males (37.5 MME) p < 0.0001, and females had a 3 minute longer PACU LOS (p < 0.0001). Increasing amounts of intraoperative opioid administration correlated with increased PACU LOS (p < 0.0001). Patients who received one opioid sparing agent intraoperatively had 3.7 times increased odds of receiving more intraoperative opioids than those who received none, and patients who received two or more opioid sparing agents intraoperatively had 2.6 times increased odds of receiving more intraoperative opioids (p < 0.0001). Increased intraoperative opioid administration was associated with increased PACU LOS. In conclusion, the utilization of preoperative and intraoperative opioid sparing agents was correlated with an increase in intraoperative opioid administration and PACU LOS, though the significance of this association is unknown, and may be related to an expectation from the anesthesia provider of increased pain and need for analgesics. The impact of sex and race on intra-operative opioid administration was unexpected and warrants further evaluation and study. Keywords: Intraoperative opioids, opioid sparing, postoperative care unit length of stay, racial disparities

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