Anesthesiology, University of California Health Sciences, La Jolla, California, USA.
Department of Anesthesiology, University of California, San Diego, California, USA.
Reg Anesth Pain Med. 2023 Aug;48(8):392-398. doi: 10.1136/rapm-2022-104055. Epub 2023 Feb 3.
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.
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).
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.
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.
有证据表明，在髋部骨折修复中使用区域麻醉具有临床益处，包括降低死亡、深静脉血栓形成、肺部并发症和心肌梗死的风险。尽管文献存在差异，但尚未研究髋部骨折手术中区域麻醉的种族差异。我们检查了种族与接受髋部骨折手术的患者的神经轴麻醉和区域阻滞的关系。
使用美国外科医师学会国家手术质量改进计划，我们确定了 2014 年至 2020 年期间年龄在 18 岁及以上的白人、黑人和亚洲人患者，并接受了髋部骨折手术。我们报告了按种族划分的区域和神经轴麻醉使用的未调整估计，并检查了社会人口统计学特征和健康状况差异。使用两个单独的多变量逻辑回归模型研究种族与接受（1）神经轴麻醉和（2）区域阻滞（即周围神经阻滞、筋膜平面阻滞）的关系。
有 104949 名患者接受了髋部骨折手术，其中 16400 名（15.6%）接受了神经轴麻醉，6264 名（5.9%）接受了区域阻滞。多变量逻辑回归分析显示，与白人患者相比，黑人患者（OR 0.67，99%CI 0.59 至 0.75，p<0.001）接受神经轴麻醉的可能性降低，而亚洲患者（OR 2.04，99%CI 1.84 至 2.26，p<0.001）接受神经轴麻醉的可能性增加。与白人患者相比，黑种人（OR 1.35，99%CI 1.17 至 1.55，p<0.001）接受区域阻滞的可能性增加。
该研究表明，髋部骨折手术中区域麻醉的使用存在种族差异。虽然本研究的结果不应被视为医疗保健差异的证据，但它可以用于支持未来旨在调查差异原因和相应患者结局的研究假设。
