The impact of opioid safety reports on racial and ethnic differences in post- operative opioid prescribing practices at hospital discharge: exploratory analysis of a clustered randomized controlled trial

Abstract Background: The objective of this study was to examine differences in postoperative opioid prescribing by race and ethnicity before and after the implementation of opioid safety reports, via a randomized control trial (RCT), to reduce guideline-discordant opioid prescribing. Methods: This exploratory analysis of an RCT used three years of data (October 2019-October 2022), two before the intervention and one during the intervention, across 19 hospitals and three surgical specialties: general surgery, obstetrics/gynecology, and orthopedic surgery. The analysis included patients ≥ 18 years of age, with known race/ethnicity (Hispanic any race, or non-Hispanic, Asian, Black, Other or white NHA, NHB, NHO, or NHW), who underwent procedures by surgeons who were randomized to receive monthly opioid safety reports (treatment arm) or not (control arm). Safety reports were based on social norms, comparing surgeons’ prescribing to guideline recommendations s or their peers. The primary outcome was total morphine milligram equivalence (MME) prescribed per patient at hospital discharge. Linear regression models were used to examine differences in prescribed total MME by race/ethnicity between control and treatment arms, before and after intervention implementation, with statistical adjustment for numerous patient, procedure, and clinician characteristics. Results: Among 55,637 patients meeting study eligibility criteria, overall trends showed decreases in opioid prescribing over time, which were more pronounced among racial/ethnic minority patients compared to NHW patients. Independent of randomized assignment, NHA and Hispanic patients received on average lower opioid quantities than NHW patients within each year, whereas NHB patients received higher opioid quantities in the first and second year and lower opioid quantities in the third year. The intervention, itself, did not impact prescribing differences by race/ethnicity across surgical specialty combined. Stratified by speciality, the intervention appeared to reduce differences in opioid prescribing for NHB vs. NHW patients undergoing obstetrics/gynecological procedures by an average of -20.8 total MME (95% Confidence Interval: -40.1, -1.5). Conclusions: Opioid safety reports, based on social norms, showed little impact on reducing gaps in opioid prescribing by race/ethnicity. Future research is needed to identify strategies to mitigate racial/ethnic postoperative opioid prescribing differences at hospital discharge.