Understanding Racial and Ethnic Disparities in Perioperative Pain Management After Routine Pediatric Tonsillectomy.

Abstract

Background: Hispanic/Latino (H/L) patients are often excluded from studies addressing pain management. Limited data suggests disparities in administration of perioperative opioid analgesia. We hypothesize that H/L patients are less likely to have their pain assessed and managed appropriately with opioids following routine pediatric tonsillectomy.

Aims: Our primary outcome was to compare the proportion of H/L patients who receive perioperative opioids to their non-H/L counterparts. Secondarily, we studied the proportion of H/L patients who had their pain score assessed.

Methods: A retrospective medical record review of patients receiving routine tonsillectomy from October 2017 to March 2022 was performed. Descriptive statistics, univariate, and multivariate analyses were conducted with levels of significance at 0.05 and calculation of adjusted odds ratios (aORs).

Results: Of 6553 patients included, 582 (9%) of those self-identified as H/L. The median age of the cohort was 5.6 years (IQR 3.4-9.1) and 53.3% identified as male. H/L patients were more likely to have a higher BMI (p < 0.001), have an income level of < $100 000/year (p < 0.001), and utilize public insurance (p < 0.001) than non-H/L patients. On multivariate analysis, non-H/L patients were less likely to receive opioids (aOR 0.78 [0.66, 0.93], p = 0.006). They were also more likely to have their pain assessed (aOR 2.38 [1.75, 3.21], p < 0.001).

Conclusions: Disparities in perioperative pain management following routine pediatric tonsillectomy exist. In contrast with current literature and our prior hypothesis, children of non-H/L ethnicity were less likely to receive opioids and more likely to have their pain assessed. Given H/L patients received fewer pain assessments, they are at risk for inferior pain management. Further understanding of factors driving differences in pain management may improve perioperative patient experience, quality of care, and aid in the creation of more standardized protocols.