Disparities in Type of Anesthesia Received  

Medicine is built on the principles of service and empathy. However, even within the walls of healthcare facilities, disparities can persist, impacting the quality of care received by patients and perpetuating health inequity. One such critical area of concern is disparities in anesthesia received, a vital component of medical procedures that ensures the comfort and safety of patients. Unfortunately, numerous studies have revealed that certain groups of patients experience unequal access and treatment in anesthesia administration, a grave example of inequity within healthcare (1-6). 

Studies focused on the health of minorities began appearing in medical literature in the 1980s, after the Department of Health and Human Services published the first comprehensive report on minority health in a document known as the “Heckler report” (2). In this report, the Department estimated that at least 60,000 excess deaths occurred every year in the United States because of racial disparities (2). Since then, health inequity has become a popular topic in research, as disparities are uncovered in the distribution of resources and quality of care across racial, socioeconomic, and gender lines. The vast majority of studies report that minorities have poorer health outcomes in every aspect of medicine, including anesthesia administration (2). 

Studying disparities specifically in anesthesia is a relatively difficult task, as anesthesiologists typically see patients only in perioperative settings — thus, they have limited interaction with patients (2). Designing methodology to analyze the role of anesthesia in health inequities has presented challenges, resulting in the first studies of potential inequities in anesthesia administration being published only in recent years (3-6). Despite the low quality of evidence, these studies highlighted several potential disparities in the anesthesia received by patients — for example, Black patients required higher doses of opioid anesthetics to control higher pain compared to their white peers after tonsillectomies (3), minority children were more likely to receive IV analgesia than white children after outpatient surgery (4), and Black and Latino children spent more time under anesthesia when receiving cranial surgery (5). Outside of racial lines, other studies attempted to investigate sex differences in anesthesia administration, but faced methodological issues (6). In multiple studies, researchers reported a lack of data as a significant obstruction in their path to making definite conclusions (2-6). 

In response to growing concerns about health inequity, anesthesiologist Alex Beletsky and other members of the American Society of Anesthesiologists assembled a subject pool of 56,881 adult patients who received anesthetic care between 2016 and 2021 for a retrospective analysis (1). Each of the patients underwent one of seven common surgical procedures, such as ankle fracture repair, carpal tunnel release, shoulder replacement, and ACL reconstruction (1). The study focused on regional anesthesia, a non-opioid analgesic technique that has been shown to ease postoperative pain and reduce the risk of complications (1). Patient factors, including sex, race, and enrollment in private versus Medicaid insurance, were analyzed against the odds of receiving this form of anesthesia (1). The results show that patients with Medicaid insurance were 39% less likely to receive regional anesthesia than patients with private insurance; racial minority patients were 29% less likely to receive regional anesthesia than white patients; and female patients were 11% less likely to receive regional anesthesia than male patients (1). Additionally, patients with more severe comorbidities were 12% less likely to receive regional anesthesia than patients with less severe conditions (1).  

Although not yet published, this study demonstrates significant disparities in the administration of anesthesia, with women, minorities, and Medicaid patients less likely to receive the standard of care (1). Beletsky pointed out that the disparities may stem from inequity within the healthcare field, which may manifest as lack of patient education or provider-patient communication (1). This study should serve as a wake-up call to the field of anesthesiology, and a reminder that medicine is not immune to inequities across gender, racial, or socioeconomic lines; however, more research is necessary to further evaluate the disparities in anesthesia care. 

References 

1: Henderson, E. 2022. Study reports disparities in the use of regional anesthesia techniques. News Medical. URL: https://www.news-medical.net/news/20221024/Study-reports-disparities-in-the-use-of-regional-anesthesia-techniques.aspx.  

2: Willer, B., Mpody, C. and Nafiu, O. 2023. Racial inequity in pediatric anesthesia. Current Anesthesiology Reports 13(2). DOI: 10.1007/s40140-023-00560-6. 

3: Sadhasivam, S., Chidambaran, V., Ngamprasertwong, P., Esslinger, H., Prows, C., Zhang, X., Martin, J. and McAuliffe, J. 2012. Race and unequal burden of perioperative pain and opioid related adverse effects in children. Pediatrics 129(5). DOI: 10.1542/peds.2011-2607. 

4: Nafiu, O., Chimbira, W., Stewart, M., Gibbons, K., Porter, L. and Reynolds, P. 2017. Racial differences in the pain management of children recovering from anesthesia. Paediatric Anaesthesia 27(7). DOI: 10.1111/pan.13163. 

5: Wallace, E., Birgfeld, C., Speltz, M., Starr, J. and Collett, B. 2019. Surgical approach and periprocedural outcomes by race and ethnicity of children undergoing craniosynostosis surgery. Plastic Reconstructive Surgery 144(6). DOI: 10.1097/PRS.0000000000006254. 

6: Etherington, N., Wu, N. and Boet, S. 2021. Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature. Korean Journal of Anesthesiology 74(1). DOI: 10.4097/kja.19484.