Association Between Race and Ethnicity in the Delivery of Regional Anesthesia for Pediatric Patients: A Single-Center Study of 3189 Regional Anesthetics in 25,664 Surgeries (original) (raw)
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Racial Inequity in Pediatric Anesthesia
Current Anesthesiology Reports
Purpose of Review Minority health disparities have receivedrenewed attention in the USA following several highly publicized racial injustices in 2020. Though the focus has been largely on adults, children are not immune to these inequities. By reviewing racial disparities in pediatric perioperative care, we aim to engage the anesthesia community in the fight against systemic racism. Recent Findings Minority children have higher rates of anesthetic and surgical morbidity compared to White children, including respiratory events, length of stay, hospital costs, and even death. These inequities occur across surgical specialties and environments. Summary Racial disparities in the perioperative health and management of children are ubiquitous. Herein, we will summarize recent pediatric health disparity literature, discuss some important contributors to persistent inequities, and propose avenues for anesthesiologists to impact the pursuit of equitable healthcare outcomes.
Racial and Ethnic Disparity in the Administration of General Anesthesia
Healthcare disparities continue to affect communities in the United States that are racially and ethnically diverse, disabled, and economically disadvantaged, even though medical and technological advancements have made great strides in these areas. Disparities in health outcomes and difficulties obtaining care for both acute and chronic illnesses are more common among these populations when compared to the overall population. Disparities in anesthesia care delivery have been documented in multiple studies, and they are based on factors such as patients' racial/ ethnic background, gender, sexual orientation, ability to communicate in English, and accessibility to health insurance.
The impact of race on analgesia use among pediatric emergency department patients
The Journal of pediatrics, 2014
We studied the effect of race on analgesia use in potentially pain-related pediatric emergency department visits using the National Hospital Ambulatory Medical Care Survey (2005-2010). There were independent patient- and hospital-level racial disparities when it came to the type of analgesia used, suggesting black children are treated differently even within hospitals with high numbers of black patients.
Epidemiology and Morbidity of Regional Anesthesia in Children
Anesthesia & Analgesia, 1996
We report the results of a prospective study on the practice of pediatric regional anesthesia by the French-Language Society of Pediatric Anesthesiologists (ADARPEF) during the period from May 1, 1993 to April 30,1994. This study was designed to provide data concerning the epidemiology of regional anesthesia and its complications in a totally anonymous way. Data from 85,412 procedures, 61,003 pure general anesthetics and 24,409 anesthetics including a regional block, were prospectively collected. Central blocks (15,013), most of which were caudals, accounted for more than 60% of all regional anesthetics. Peripheral nerve blocks and local anesthesia techniques represented only 38% of regional blocks and Bier block was used only 69 times. Central and peripheral nerve blocks were performed in all pediatric age groups with some intergroup differences. Most blocks were performed under light general anesthesia (89%), confirming the fact that regional anesthetics are used as techniques of analgesia rather than anesthesia. Complications were rare (25 incidents involving 24 patients) and minor, and did not result in any sequelae or medicolegal action. Peripheral nerve blocks and local anesthesia techniques were generally safe.
Perioperative Analgesic Treatment in Latino and non-Latino Pediatric Patients
Journal of Health Care for the Poor and Underserved, 2010
Purpose-Adult studies suggest pain treatment is influenced by patient's race/ethnicity. The present study aims to evaluate the effect of the patient's race/ethnicity on pain treatment in children. Methods-Retrospective cohort study comparing perioperative analgesic administration for tonsillectomy and adenoidectomy (T&A) surgery in Latino and Caucasian patients younger than 18 years of age. Results-Ninety-four (94) patients were included (47 Latino, 47 Caucasian), mean age 8.44 yrs (SD 3.45), 43% female. Administration of non-opioid analgesics and intraoperative opioids was similar in both groups. Early post-operative administration of opioid analgesics was significantly different between groups. Latino subjects received 30% less opioid analgesics than Caucasians; median amount in morphine equivalents was 0.05 (0-0.14) vs. 0.07 (0-0.90) mg/kg for Latino and Caucasian patients respectively (p=.02). Conclusion-This study suggests that perioperative pain treatment in children is correlated with the patient's ethnicity. The cause of this difference is unknown and prospective studies are necessary to elucidate the reasons.
Differences in Regional Anesthesia Utilization by Hospital Region in the United States
Background Regional anesthesia (RA) has demonstrated distinct advantages over general anesthesia, including decreased infection risk, lower rates of complications, and improved patient satisfaction. As such, the rate of RA utilization has been increasing, particularly among outpatient orthopedic surgeries like total hip arthroplasty and total knee arthroplasty. However, no studies have examined utilization rates as a function of hospital region. Methods A national hospital database (Hospital Corporation of American, HCA) was queried for patients 18 years or older that received selected surgical procedure codes between January 2016 and June 2021. The included CPT codes were for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), anterior cruciate ligament reconstruction (ACLR), carpal tunnel release, total abdominal hysterectomy (TAH), open reduction and internal fixation (ORIF) of the ankle, and arteriovenous (AV) fistula creation. Regional anesthesia was defined as an...
Children
Background: Family-centered care aims to consider family preferences and values in care delivery. Our study examines parent decisions regarding anesthesia type (caudal regional block or local anesthesia) among a diverse sample of children undergoing urologic surgeries. Differences in anesthesia type were examined by known predictors of health disparities, including child race/ethnicity, parental English proficiency, and a proxy for household income. Methods: A retrospective review of 4739 patients (including 25.4% non-Latino/a White, 8.7% non- Latino/a Asians, 7.3% non-Latino/a Black, 23.1% Latino/a, and 35.4% others) undergoing urologic surgeries from 2016 to 2020 using univariate and logistic regression analyses. Results: 62.1% of Latino/a parents and 60.8% of non-Latino/a Black parents did not agree to a regional block. 65.1% of Spanish-speaking parents with limited English Proficiency did not agree to a regional block. Of parents from households below poverty lines, 61.7% did no...