Association of Race, Ethnicity, and Language in the Administration of Multimodal Pain Medications in Elective...

Up to 20% of patients do not receive multimodal pain medications when ordered. We hypothesized that racial/ethnic minority and non-English language preference (NELP) patients were less likely to be administered postoperative multimodal pain medications.

We conducted a secondary analysis of a randomized controlled trial, examining adults admitted for elective surgery between January 2020 and March 2023 at a single academic center with a nonsteroidal anti-inflammatory drug (NSAID) or acetaminophen (APAP) ordered around the clock by the end of postoperative day 1 (n = 29,016). Exposures were combined race/ethnicity and language preference; outcomes were the proportion of patients receiving NSAIDs or APAP by the end of postoperative day 1. We adjusted for confounding variables, running separate logistic regressions for each predictor due to collinearity concerns.

Asian race (adjusted odds ratio [aOR] 0.67, 95% confidence interval [CI] [0.49, 0.91], P value = 0.010) was associated with lower adjusted odds of NSAID administration. NELP (aOR 0.69, 95% CI [0.49, 0.98], P = 0.037) was associated with lower adjusted odds of NSAID administration. Asian (aOR 0.70, 95% CI [0.59, 0.84], P value < 0.001) and African American race (aOR 0.77, 95% CI [0.61, 0.97], P = 0.025) were associated with lower adjusted odds of APAP administration. NELP (aOR 0.68, 95% CI [0.56, 0.82], P < 0.001) was associated with lower adjusted odds of APAP administration. Of 10,796 encounters with NSAIDs ordered, 4.0% had nonadministration. Of 28,664 encounters with APAP ordered, 4.2% had nonadministration.

Among adults admitted for elective surgery with scheduled NSAIDs or APAP ordered, Asian or NELP patients had lower adjusted odds of NSAID administration, while Asian, African American, or NELP patients had lower adjusted odds of APAP administration.