Pain Treatment Strategy and Readmission Rates for Medicare Beneficiaries Post-Acute Ischemic Stroke

Purpose Stroke is highly prevalent and commonly presents with pain. Primary care providers generally manage follow-up care, although ideal pain management strategies remain unclear. Treatment options include gabapentinoids, tricyclic antidepressants, and various antiseizure medications. We aim to analyze differences in hospital readmissions, a quality metric, for those initiating gabapentin in contrast to other medicines for post-stroke pain in older adults.

In this matched cohort study, we analyzed a 20% sample of U.S. Medicare beneficiaries aged 65 and over hospitalized for acute ischemic stroke (AIS) between December 31, 2016, and December 31, 2021, who were discharged home. Individuals met insurance coverage criteria and did not take pain medications before hospitalization. We matched individuals on days from discharge to medication initiation. Individuals who initiated Gabapentin within 90 days of discharge (N = 1,546) were matched to individuals who initiated first-line pharmacological treatments for nerve pain other than Gabapentin within 90 days of discharge (N = 285). We investigated the time to re-admissions using a semi-competing risk framework.

The matched cohort of 1,831 initiators had a median age of 76 (IQR 11) and was 57.2% female and 81.3% Non-Hispanic White. Using the semi-competing risk framework, the hazard of readmissions, given that death had not occurred, was not different for Gabapentin initiators, compared to if they had initiated other medications, hazard ratio 0.871 (95% CI: 0.517, 1.466).

We found no significant difference in hospital readmission rates between gabapentin and other post-stroke pain treatment strategies. Our findings contribute to the pharmacosurveillance of gabapentin in real-world Medicare beneficiaries. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was conducted under the following NIH grant: 1R01AG073410-01 Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Mass General Brigham gave ethical approval of this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Research funding: This project was conducted under the following NIH grant: 1R01AG073410-01 Data Availability We had a Data Use Agreement approved by the Center for Medicare & Medicaid Services (DUA RSCH-2022-58182). Interested researchers may replicate the study by obtaining the data from CMS. Reproducing this study requires 20% MedPAR, Outpatient, Carrier, and Part D standard analytical files.