From the Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas.
Anesth Analg. 2023 Sep 1;137(3):665-675. doi: 10.1213/ANE.0000000000006509. Epub 2023 May 19.
Postoperative nausea and vomiting (PONV) prophylaxis is consistently considered a key indicator of anesthesia care quality. PONV may disproportionately impact disadvantaged patients. The primary objectives of this study were to examine the associations between sociodemographic factors and the incidence of PONV and clinician adherence to a PONV prophylaxis protocol.
We conducted a retrospective analysis of all patients eligible for an institution-specific PONV prophylaxis protocol (2015-2017). Sociodemographic and PONV risk data were collected. Primary outcomes were PONV incidence and clinician adherence to PONV prophylaxis protocol. We used descriptive statistics to compare sociodemographics, procedural characteristics, and protocol adherence for patients with and without PONV. Multivariable logistic regression analysis followed by Tukey-Kramer correction for multiple comparisons was used to test for associations between patient sociodemographics, procedural characteristics, PONV risk, and (1) PONV incidence and (2) adherence to PONV prophylaxis protocol.
Within the 8384 patient sample, Black patients had a 17% lower risk of PONV than White patients (adjusted odds ratio [aOR], 0.83; 95% confidence interval [CI], 0.73-0.95; P = .006). When there was adherence to the PONV prophylaxis protocol, Black patients were less likely to experience PONV compared to White patients (aOR, 0.81; 95% CI, 0.70-0.93; P = .003). When there was adherence to the protocol, patients with Medicaid were less likely to experience PONV compared to privately insured patients (aOR, 0.72; 95% CI, 0.64-1.04; P = .017). When the protocol was followed for high-risk patients, Hispanic patients were more likely to experience PONV than White patients (aOR, 2.96; 95% CI, 1.18-7.42; adjusted P = .022). Compared to White patients, protocol adherence was lower for Black patients with moderate (aOR, 0.76; 95% CI, 0.64-0.91; P = .003) and high risk (aOR, 0.57; 95% CI, 0.42-0.78; P = .0004).
Racial and sociodemographic disparities exist in the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. Awareness of such disparities in PONV prophylaxis could improve the quality of perioperative care.
术后恶心和呕吐（PONV）的预防一直被认为是麻醉护理质量的关键指标。PONV 可能会对处于不利地位的患者产生不成比例的影响。本研究的主要目的是检查社会人口统计学因素与 PONV 发生率以及临床医生对 PONV 预防方案的遵循之间的关联。
我们对符合机构特定 PONV 预防方案（2015-2017 年）的所有患者进行了回顾性分析。收集了社会人口统计学和 PONV 风险数据。主要结局是 PONV 的发生率和临床医生对 PONV 预防方案的依从性。我们使用描述性统计来比较有和没有 PONV 的患者的社会人口统计学、手术特征和方案依从性。多变量逻辑回归分析后，采用 Tukey-Kramer 校正进行多重比较，以测试患者社会人口统计学、手术特征、PONV 风险与（1）PONV 发生率和（2）对 PONV 预防方案的依从性之间的关联。
在 8384 例患者样本中，黑人患者发生 PONV 的风险比白人患者低 17%（调整后的优势比 [aOR]，0.83；95%置信区间 [CI]，0.73-0.95；P =.006）。当遵循 PONV 预防方案时，与白人患者相比，黑人患者发生 PONV 的可能性较小（aOR，0.81；95%CI，0.70-0.93；P =.003）。当遵循该方案时，与私人保险患者相比，拥有医疗补助的患者发生 PONV 的可能性较低（aOR，0.72；95%CI，0.64-1.04；P =.017）。当对高危患者遵循该方案时，与白人患者相比，西班牙裔患者发生 PONV 的可能性更高（aOR，2.96；95%CI，1.18-7.42；调整后的 P =.022）。与白人患者相比，中等风险（aOR，0.76；95%CI，0.64-0.91；P =.003）和高风险（aOR，0.57；95%CI，0.42-0.78；P =.0004）的黑人患者对方案的依从性较低。
PONV 的发生率和临床医生对 PONV 预防方案的遵循存在种族和社会人口统计学差异。对 PONV 预防中存在的这些差异的认识可以提高围手术期护理的质量。
