Disparities in Regional Anesthesia Application during Inpatient Surgery

Abstract

Abstract: Introduction: The purpose of this study was to determine if there are any factors that affect the utilization rates of regional anesthesia techniques with regards to the inpatient procedures; knee arthroplasty as inpatient, mastectomy, colectomy, and coronary artery bypass graft. Methods: Utilizing the HCUP database for inpatient procedures and hospitalizations, data from 2020 that including ICD10 codes specific for these four procedures as well as those indicative for regional anesthesia were compared against those who did not receive regional anesthesia for the same surgical procedure codes. Data compared patients with a population size of 32,355,827. Data compared between groups included controlling for age, gender, income quartile, and insurance payor. Demographic information included age, gender, race, income quartile (fourth quartile being highest at $86,000+ and first quartile the lowest at $49,999 and below), and payor. Multivariable logistic regression was performed to determine odds of binary clinical outcomes relative to patient and hospital characteristics. All p-values 2-sided and p<0.05 were considered statistically significant. Results: Race based comparisons showed no statistically significant p-value regarding group-to-group odds ratios. There were significant differences for self-pay and private insurance groups when compared to Medicare groups for individuals undergoing colectomy, OR 7.7, 6 (95% CI 1.4-42 and 1.2-29.8 respectively). For mastectomy a similar result was seen with statistically significant OR of 1.4 (95% CI 1.1-1.8). for increased utilization of regional anesthesia for private insurance as compared to Medicare. Additionally in the mastectomy group a significant OR 1.6 was seen for the fourth quartile income zip code individuals as compared to first quartile (95% CI 1.2-2.2). There was also a trend toward significance of decreased regional anesthesia in mastectomy use with the Medicaid group OR 0.7 (95% CI 0.5-1). CABG group comparisons as broken down by zip code income quartile also showed fourth quartile OR of 2.1 (95% CI 1.2-3.8). There was also statistical significance seen in the CABG and mastectomy groups when comparing age with those receiving regional anesthesia being younger; for CABG no regional mean age of 68 as compared to regional mean age 65.7(OR .98 95% CI .97-.99) and mastectomy no regional mean age 70.2 as compared to regional mean age 65 (OR .98 95% CI .97-.99). Conclusion: There is a strong possibility that healthcare is improving equity in treatment across racial groups, but more work needs to be done to continue to investigate other socio-economic disparities and related care applications. This study indicates that those with a higher income quartile and private insurance were more likely to receive regional anesthesia, which often results in faster recovery and return to activity.