Racial and Socioeconomic Disparities in Peripheral Nerve Block Administration for Upper Extremity Surgery
Mariana D. Hoyos, Scott N. Loewenstein, Joshua M. Adkinson, Brian M. Christie
Indiana University School of Medicine
Presenter: Scott Loewenstein; Mariana Hoyos
I, William Wooden, certify that this abstract is an original project performed by the authors listed above. Mariana Hoyos performed the literature review, analyzed results and wrote all of the sections of the current paper including the abstract. Scott Loewenstein performed the statistical analysis. All Co-Authors have provided invaluable feedback to each edited version of the current paper.
Director Name: William A. Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Disparities in healthcare and the extent to which they impact patient outcomes remain a significant health policy issue. The purpose of this study was to identify potential disparities in the use of peripheral nerve blocks (PNBs).
We built a database of demographics, comorbidities and procedures for patients who underwent outpatient upper extremity surgery from 2009 through 2019 using the Indiana Network for Patient Care. We analyzed for disparities using univariate, bivariate and multivariate logistic regression analyses.
Of the 34,730 patients meeting inclusion criteria, 4,731 (13.6%) received a PNB prior to surgery. Patients with commercial insurance compared to Medicaid/Medicare (9.3% versus 2.8%, OR 2.83), and Whites compared to minorities (9.3% versus 6.8%) more often received a block (p<0.001). Median income was higher among patients who received a block (p<0.001). There were increased odds for PNBs in patients with a history of pre-procedural opioid use, depression, and anxiety. Compared to first dorsal compartment release, PNB odds were higher for tendon transfers, carpometacarpal arthroplasties, and cubital tunnel release, and lower for excision of soft tissue tumors and ganglion cysts.
PNBs are less commonly utilized among racial minorities and populations of lower socioeconomic status even when accounting for confounding medical comorbidities and procedures. PNB's have been shown superior to general anesthesia and systemic medications for post-operative pain control. These findings highlight the need for attention to bias regarding non-medical differences such as race and socioeconomic status when deciding to offer a PNB for eligible patients undergoing upper extremity surgery.
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