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Original research
Association of race and receipt of regional anesthesia for hip fracture surgery
  1. Adam N Schaar1,
  2. John J Finneran2 and
  3. Rodney A Gabriel3
  1. 1Anesthesiology, University of California Health Sciences, La Jolla, California, USA
  2. 2Department of Anesthesiology, University of California, San Diego, California, USA
  3. 3Anesthesiology, University of California, La Jolla, California, USA
  1. Correspondence to Dr Rodney A Gabriel, Anesthesiology, University of California San Diego, La Jolla, California 92093, USA; ragabriel{at}health.ucsd.edu

Abstract

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.

  • analgesia
  • Nerve Block
  • Outcome Assessment, Health Care

Data availability statement

Data may be obtained from a third party and are not publicly available. NSQIP.

https://doi.org/10.1136/rapm-2022-104055

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. NSQIP.

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    Footnotes

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.