From the Departments of Anesthesiology and Critical Care Medicine.
Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
Anesth Analg. 2022 Jul 1;135(1):170-177. doi: 10.1213/ANE.0000000000006058. Epub 2022 Apr 25.
Peripheral nerve blocks (PNBs) are used to provide postoperative analgesia after total mastectomy. PNBs improve patient satisfaction and decrease postoperative opioid use, nausea, and vomiting. Few studies have examined whether there is racial-ethnic disparity in the use of PNBs for patients having total mastectomy. We hypothesized that non-Hispanic Asian, non-Hispanic Black, non-Hispanic patients of other races, and Hispanic patients would be less likely to receive a PNB for postoperative analgesia compared to non-Hispanic White patients having total mastectomy. Secondarily, we hypothesized that PNBs would be associated with reduced odds of major complications after total mastectomy.
We performed a retrospective cohort study using National Surgical Quality Improvement Program (NSQIP) data from 2015 to 2019. Patients were included if they underwent total mastectomy under general anesthesia. Unadjusted rates of PNB use were compared between race-ethnicity groups. Multivariable logistic regression was performed to determine whether race-ethnicity group was independently associated with receipt of a PNB for postoperative analgesia. Secondarily, we calculated crude and risk-adjusted odds ratios for major complications in patients who received a PNB.
There were 64,103 patients who underwent total mastectomy and 4704 (7.3%) received a PNB for postoperative analgesia. Patients who received a PNB were younger, more commonly women, were less likely to have diabetes and hypertension, and had less disseminated cancer (all P < .05). In our regression analysis, the odds of receiving a PNB differed significantly by race-ethnicity group (P < .001). Non-Hispanic Asian and non-Hispanic Black patients had reduced odds of receiving a PNB compared to non-Hispanic White patients (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.33-0.49 and OR, 0.37 [0.32-0.44]), respectively. Non-Hispanic patients of other races, including American Indian, Alaskan Native, and Pacific Islander, also had reduced odds of receiving a PNB (OR, 0.73 [95% CI, 0.64-0.84]) compared to non-Hispanic White patients, as did Hispanic patients (OR, 0.62 [0.56-0.69]). Patients who received a PNB did not have reduced odds of major complications after mastectomy (crude OR, 0.83 [0.65-1.08]; P = .17 and adjusted OR, 0.85 [0.65-1.10]; P = .21).
Significant disparity exists in the use of PNBs for postoperative analgesia in patients of different race-ethnicity who undergo total mastectomy in the United States. Continued efforts are needed to better understand the causes of disparity and to ensure equitable access to PNBs.
外周神经阻滞（PNB）用于提供全乳切除术后的术后镇痛。PNB 可提高患者满意度，减少术后阿片类药物的使用、恶心和呕吐。很少有研究检查全乳切除术后使用 PNB 是否存在种族差异。我们假设与接受全乳切除术的非西班牙裔白人患者相比，非西班牙裔亚洲人、非西班牙裔黑人、其他种族的非西班牙裔患者和西班牙裔患者接受 PNB 进行术后镇痛的可能性较小。其次，我们假设 PNB 与全乳切除术后主要并发症的几率降低相关。
我们使用 2015 年至 2019 年国家手术质量改进计划（NSQIP）的数据进行了回顾性队列研究。如果患者在全身麻醉下接受全乳切除术，则将其纳入研究。比较了不同种族群体之间 PNB 使用的未调整率。多变量逻辑回归用于确定种族群体是否与接受 PNB 进行术后镇痛独立相关。其次，我们计算了接受 PNB 的患者发生主要并发症的粗风险比和风险调整比。
共有 64103 名患者接受全乳切除术，其中 4704 名（7.3%）接受 PNB 进行术后镇痛。接受 PNB 的患者年龄较小，更常见为女性，糖尿病和高血压的患病率较低，且癌症扩散程度较低（均 P <.05）。在我们的回归分析中，不同种族群体接受 PNB 的几率差异具有统计学意义（P <.001）。与非西班牙裔白人患者相比，非西班牙裔亚洲人和非西班牙裔黑人患者接受 PNB 的几率明显降低（比值比 [OR]，0.41；95%置信区间 [CI]，0.33-0.49 和 OR，0.37 [0.32-0.44]）。非西班牙裔其他种族（包括美国印第安人、阿拉斯加原住民和太平洋岛民）的患者接受 PNB 的几率也降低（OR，0.73 [95% CI，0.64-0.84]），而西班牙裔患者接受 PNB 的几率也降低（OR，0.62 [0.56-0.69]）。接受 PNB 的患者在接受乳房切除术后发生主要并发症的几率并未降低（未校正 OR，0.83 [0.65-1.08]；P =.17 和校正 OR，0.85 [0.65-1.10]；P =.21）。
在美国接受全乳切除术的不同种族患者中，PNB 用于术后镇痛的使用存在显著差异。需要继续努力更好地了解差异的原因，并确保 PNB 的公平获取。
