Jennie Meier1, Audrey Stevens2, Miles Berger3, Timothy P Hogan4, Joan Reisch5, C Munro Cullum6, Simon C Lee5, Celette Sugg Skinner5, Herbert Zeh7, Cynthia J Brown8, Courtney J Balentine2. 1. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; North Texas VA Healthcare System, Dallas, Texas; University of Texas Southwestern Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, Texas. Electronic address: Jennie.meier@utsouthwestern.edu. 2. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; North Texas VA Healthcare System, Dallas, Texas; University of Texas Southwestern Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, Texas. 3. Department of Anesthesiology, Duke University, Durham, North Carolina. 4. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers. 5. Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas. 6. Memorial Veterans Hospital, US Department of Veterans Affairs, Bedford Massachusetts, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas. 7. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. 8. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.
Abstract
BACKGROUND: Many studies have identified racial disparities in healthcare, but few have described disparities in the use of anesthesia modalities. We examined racial disparities in the use of local versus general anesthesia for inguinal hernia repair. We hypothesized that African American and Hispanic patients would be less likely than Caucasians to receive local anesthesia for inguinal hernia repair. MATERIALS AND METHODS: We included 78,766 patients aged ≥ 18 years in the Veterans Affairs Surgical Quality Improvement Program database who underwent elective, unilateral, open inguinal hernia repair under general or local anesthesia from 1998-2018. We used multiple logistic regression to compare use of local versus general anesthesia and 30-day postoperative complications by race/ethnicity. RESULTS: In total, 17,892 (23%) patients received local anesthesia. Caucasian patients more frequently received local anesthesia (15,009; 24%), compared to African Americans (2353; 17%) and Hispanics (530; 19%), P < 0.05. After adjusting for covariates, we found that African Americans (OR 0.82, 95% CI 0.77-0.86) and Hispanics (OR 0.77, 95% CI 0.69-0.87) were significantly less likely to have hernia surgery under local anesthesia compared to Caucasians. Additionally, local anesthesia was associated with fewer postoperative complications for African American patients (OR 0.46, 95% CI 0.27-0.77). CONCLUSIONS: Although local anesthesia was associated with enhanced recovery for African American patients, they were less likely to have inguinal hernias repaired under local than Caucasians. Addressing this disparity requires a better understanding of how surgeons, anesthesiologists, and patient-related factors may affect the choice of anesthesia modality for hernia repair.
BACKGROUND: Many studies have identified racial disparities in healthcare, but few have described disparities in the use of anesthesia modalities. We examined racial disparities in the use of local versus general anesthesia for inguinal hernia repair. We hypothesized that African American and Hispanic patients would be less likely than Caucasians to receive local anesthesia for inguinal hernia repair. MATERIALS AND METHODS: We included 78,766 patients aged ≥ 18 years in the Veterans Affairs Surgical Quality Improvement Program database who underwent elective, unilateral, open inguinal hernia repair under general or local anesthesia from 1998-2018. We used multiple logistic regression to compare use of local versus general anesthesia and 30-day postoperative complications by race/ethnicity. RESULTS: In total, 17,892 (23%) patients received local anesthesia. Caucasian patients more frequently received local anesthesia (15,009; 24%), compared to African Americans (2353; 17%) and Hispanics (530; 19%), P < 0.05. After adjusting for covariates, we found that African Americans (OR 0.82, 95% CI 0.77-0.86) and Hispanics (OR 0.77, 95% CI 0.69-0.87) were significantly less likely to have hernia surgery under local anesthesia compared to Caucasians. Additionally, local anesthesia was associated with fewer postoperative complications for African American patients (OR 0.46, 95% CI 0.27-0.77). CONCLUSIONS: Although local anesthesia was associated with enhanced recovery for African American patients, they were less likely to have inguinal hernias repaired under local than Caucasians. Addressing this disparity requires a better understanding of how surgeons, anesthesiologists, and patient-related factors may affect the choice of anesthesia modality for hernia repair.
Authors: Courtney J Balentine; Jennie Meier; Miles Berger; Timothy P Hogan; Joan Reisch; Munro Cullum; Herbert Zeh; Simon C Lee; Celette Sugg Skinner; Cynthia J Brown Journal: Am J Surg Date: 2020-08-25 Impact factor: 2.565