Laird Harrison

November 04, 2015

SAN DIEGO — During hip and knee replacement surgery, black and Hispanic patients are less likely to receive regional anesthesia than white patients, new research suggests.

This disparity could put these groups at greater risk for serious complications, including death, said Crispiana Cozowicz, MD, from Paracelsus Medical University of Salzburg in Austria.

"In the past few years, evidence has emerged that anesthesia has an impact on surgical outcomes," she told Medscape Medical News here at Anesthesiology 2015.

Although previous studies have shown disparities in medical treatment between ethnic minorities and white patients, few researchers have examined this possibility in anesthesia.

Dr Cozowicz and her colleagues identified 1,062,152 hip and knee replacement surgeries performed from 2006 to 2013 that were entered in Premier Perspective, a national claims database.

Neuraxial Anesthesia, Peripheral Nerve Block

Neuraxial anesthesia was used in 236,083 of these procedures (22.2%) and peripheral nerve block was used in 189,732 (17.9%). During the study period, the use of neuraxial anesthesia decreased and the use of peripheral nerve block increased.

Regional anesthesia was used less often in black and Hispanic patients than in white patients, despite similar rates of comorbidity.

Older patients were more likely to receive regional anesthesia than younger patients.

Medicaid patients were 22% less likely to receive neuraxial anesthesia than patients with private insurance (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.74 - 0.82), and patients with no insurance were 11% less likely (OR, 0.89; 95% CI, 0.81 - 0.98).

And patients treated at a teaching hospital were 65% less likely to receive neuraxial anesthesia than those treated at a nonteaching hospital (OR, 0.35; 95% CI, 0.14 - 0.89).

 
It looks like disparities are there.
 

Even after adjustment for other factors — such as insurance status, sex, hospital location, year of procedure, type of procedure, hospital size, and type of comorbidity — black patients were 12% less likely than white patients to receive neuraxial anesthesia (OR, 0.88; 95% CI, 0.86 - 0.91) and Hispanic patients were 40% less likely than white patients to receive peripheral nerve block (OR, 0.60, 95% CI, 0.56 - 0.65).

"It looks like disparities are there," said Dr Cozowicz, but she acknowledged that an analysis of a database does not identify the reasons for this.

More research is needed to explore disparities in the use of anesthesia, said session moderator Peter Killoran, MD, from the University of Texas Health Science Center at Houston.

"Cultural preferences emerge that are based on factors we don't understand," he told Medscape Medical News.

Dr Cozowicz and Dr Killoran have disclosed no relevant financial relationships.

Anesthesiology 2015 from the American Society of Anesthesiologists (ASA): Abstract 1056. Presented October 25, 2015.

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