The Relationship Between Limited English Proficiency and Discharge Opioid Prescription Among Patients Undergoing Operation

Abstract

INTRODUCTION: Barriers to effective communication may negatively impact pain assessment and the decision to prescribe opioids. In this study, we examine the relationship between limited English proficiency (LEP) and postoperative opioid prescribing. METHODS: This is a cross-sectional study of patients undergoing operation across a large healthcare delivery system between 2016 and 2020. Discharge opioid prescription was converted to morphine milligram equivalents (MME). Odds of being prescribed an MME dose below the 25th percentile and above the 75th percentile were compared between English proficient (EP) and LEP patients using multivariable logistic regression. RESULTS: Among 89,383 patients included in this study (mean age 52.13 years, 51% female), 7.4% had LEP; 21.6% (95% CI 21.3% to 21.8%) of EP patients and 28.5% (95% CI 27.4% to 29.6%) of LEP patients were not prescribed opioids. Among those who had an opioid prescription, the median (interquartile range [IQR]) MME was lower in LEP compared with EP patients (150 [75 to 225] vs 180 [96 to 315]). Median MME at discharge varied across surgical specialties (Fig. 1). Patients with LEP had higher odds of being prescribed lowest quartile MME (odds ratio [OR] 1.32, 95% CI 1.21 to 1.43) and lower odds of being prescribed highest quartile MME (OR 0.66, 95% CI 0.59 to 0.73) compared with EP patients after adjustment for clinical characteristics and surgical specialty.CONCLUSION: No opioid prescribing and less opioid prescribing occurred more often in LEP patients. If these differences result in inadequate pain management, this may be an opportunity for performance improvement. Given that larger MME prescriptions can be problematic, the clinical impact of these differences remains to be determined.