Early post-operative opioid fills after cancer-directed surgery among Medicare beneficiaries by race and ethnicity.

Abstract

1594 Background: Post-operative pain is often underestimated and undertreated. Researchers have shown that Black patients receive fewer opioids than White patients across multiple settings and conditions; however, little is known about whether post-operative opioid prescribing for cancer-directed surgery differs by race and ethnicity. We characterized racial and ethnic differences in opioid fills among Medicare beneficiaries undergoing cancer-directed surgery. Methods: Using 100% Medicare data for fee-for-service beneficiaries enrolled in parts A, B, and D, we identified episodes of cancer-directed surgeries from 2012-2021 among adults who survived > 30d after surgery and were discharged home. We used Part D claims to identify opioid prescriptions filled in the 30d after outpatient surgeries and the 30d after hospital discharge for inpatient surgeries, overall and among non-Hispanic White (NHW), Black (NHB), Hispanic, and Asian patients. Results: Among 981,702 surgical episodes (mean age 73 [SD 8] years, 36% male), 83% were NHW, 8% NHB, 4% Hispanic and 2% Asian patients. Most surgeries were for breast (38%), colorectal (15%), prostate (13%), or lung (10%) cancers. Most (67%) patients with surgical episodes had an opioid fill within 30d, with a mean dose of 246 morphine milligram equivalents (MMEs) in the first prescription, and a mean total dose of 360 MMEs filled within 30d of surgery or discharge. On average, patients filled 1.4 opioid prescriptions, with a mean of 9-days’ supply in the 30d after surgery or discharge. NHB patients had the highest rate of opioid prescription, doses, and days’ supply; Asian patients had the lowest rate of opioid prescriptions, doses, and days’ supply (Table). Findings among Hispanic patients mirrored NHW patients. Conclusions: Among Medicare beneficiaries undergoing cancer-directed surgeries in 2012-2021, two-thirds of surgical episodes were associated with an opioid fill. In contrast to prior studies of opioid fills among cancer patients, we observed the highest opioid fills among Black patients. Future work is needed to understand the association of time and patient, physician, and healthcare factors on post-operative opioid prescribing and to understand the association of opioid prescribing with pain control. Outcome in 30dMean (SD) Overall(n=981702) NHW(n=815966) NHB(n=77932) Hispanic(n=42663) Asian(n=21087) Filling an opioidn (%) 653883 (67%) 538183 (66%) 58323 (75%) 28866 (68%) 12937 (61%) MME, first prescription 246 (320) 245 (318) 271 (350) 243 (318) 211 (210) Total MME in 30d 360 (566) 356 (563) 420 (620) 358.9 (565) 276 (374) # of fills 1.4 (0.8) 1.4 (0.8) 1.5 (0.8) 1.4 (0.8) 1.3 (0.6) Days prescribed 9 (9) 9 (9) 10 (10) 9 (9) 8 (7) MME=morphine milligram equivalents.