Background Knee osteoarthritis (OA) is one of the leading causes of disability in the U. S. , leading to functional decline and worsening quality of life in patients. Total knee arthroplasty (TKA) has increased in popularity for knee OA, however the rehabilitation process after the procedure is associated with varying pain levels, including severe breakthrough pain, which may affect the outcomes in patients where pain is not adequately controlled. While socioeconomic disparities have been studied in TKA and pain management, there is limited data on the presence of disparities in post-operative pain management after TKA. Analysis of such data is important to reduce health care disparities and improve procedure outcomes in these subgroups. Objective To analyze socioeconomic disparities in post-operative pain management after total knee replacement Method This is a retrospective study from 2012-2022 across 10 facilities from a single statewide health network in Indiana looking at patients over 18 years old who underwent TKA secondary to osteoarthritis. Data on demographics, insurance, socioeconomic status, comorbidities, and postoperative stay including medication administration and pain scores was collected from the electronic medical record. ANOVA and Chi Square analyses were performed to examine the relationship between number of opioid administrations, number of analgesic administrations, length of admission, pre-operative pain score, postoperative pain score, and pain at initial follow-up across race, ethnicity, sex, insurance, and income categories. A 5% significance level was used for all analyses. Results There was a difference in the preoperative, post-operative, and follow-up visit pain scores reported by patients after TKA. Black patients were found to have elevated pain scores in the preoperative, postoperative, and initial follow-up (p<0. 001). Similar findings were seen with uninsured patients, females, and patients in the lowest income category (< 50, 496). There was a significant difference in number of times opioids were administered for pain control after the procedure when analyzed by race (p=0. 024), sex (p<0. 001), and income (p<0. 001). There was a significant difference in the number of times analgesics were administered for pain control after the procedure when analyzed by insurance and income (p<0. 001). Conclusion Socioeconomic disparities are present in pain management after total knee arthroplasty, most noticed with preoperative, postoperative, and initial follow-up visit pain scores. Disparities in pain management can be seen in race, income, sex, and type of insurance.
Alcaide et al. (Tue,) studied this question.