Background There is evidence suggesting clinical benefits of regional anesthesia use in the setting of hip fracture repair, including reduced risk of death, deep vein thrombosis, pulmonary complications and myocardial infarction. Thought the literature is mixed, the use of regional anesthesia in hip fracture surgery has not been studied for racial differences. We examined the association of race with neuraxial anesthesia and regional blocks in patients undergoing hip fracture surgery.
Methods Using American College of Surgeons National Surgical Quality Improvement Program, we identified patients ≥18 years old who were either white, black or Asian and underwent hip fracture surgery from 2014 to 2020. We reported unadjusted estimates of both regional and neuraxial anesthesia use by race and examined sociodemographic characteristics and health status differences. Two separate multivariable logistic regression models were employed to investigate the association of race with the receipt of (1) neuraxial anesthesia and (2) regional block (ie, peripheral nerve blocks, fascial plane blocks).
Results There were 104,949 patients who underwent hip fracture surgery, of whom 16,400 (15.6%) received a neuraxial anesthetic and 6264 (5.9%) received a regional block. On multivariable logistic regression analysis, compared with white patients, black patients (OR 0.67, 99% CI 0.59 to 0.75, p<0.001) had decreased odds, while Asian patients (OR 2.04, 99% CI 1.84 to 2.26, p<0.001) had increased odds for receipt of neuraxial anesthesia as a primary anesthetic. Black race (OR 1.35, 99% CI 1.17 to 1.55, p<0.001) was associated with increased odds for receiving a regional block compared with white patients.
Conclusions The study suggests that racial differences exist with the utilization of regional anesthesia for hip fracture surgery. While the results of this study should not be taken as evidence for healthcare disparities, it could be used to support hypotheses for future studies that aim to investigate causes of disparities and corresponding patient outcomes.
- Nerve Block
- Outcome Assessment, Health Care
Data availability statement
Data may be obtained from a third party and are not publicly available. NSQIP.
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Contributors ANS: This author helped design the study, acquire, analyze, and interpret the data, draft the initial manuscript, and critically revise the manuscript. JJF: This author helped design the study, acquire, analyze, and interpret the data, draft the initial manuscript, and critically revise the manuscript. RG: This author helped design the study, acquire, analyze, and interpret the data, draft the initial manuscript, and critically revise the manuscript. RG is the guarantor of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RG’s institution received funding for research unrelated to this manuscript: Epimed, Teleflex, and SPR Therapeutics. RG had received a one-time honorarium for consulting with Heron Therapeutics in 2018. RG’s institution serves as a consultant for Avanos, in which RG represents.
Provenance and peer review Not commissioned; externally peer reviewed.
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