From the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Anesth Analg. 2024 Nov 1;139(5):921-930. doi: 10.1213/ANE.0000000000006764. Epub 2024 May 20.
Racial and ethnic concordance between patients and health care providers increases patient satisfaction but has not been examined in obstetric anesthesia care. This study evaluated the association between racial and ethnic concordance and satisfaction with management of pain during cesarean delivery (PDCD).
This was a secondary analysis on a cohort of patients undergoing cesarean deliveries under neuraxial anesthesia that examined PDCD. The outcome was satisfaction, recorded within 48 hours after delivery using the survey question, "Overall, how satisfied are you with the anesthesia care during the C-section as it relates to pain management?" Using a 5-point Likert scale, satisfaction was defined with the answer "very satisfied." Participants were also asked, "If you have another C-section, would you want the same anesthesia team?" The exposure was racial and ethnic concordance between the patient and anesthesia team members (attending with a resident, nurse anesthetist, or fellow) categorized into full concordance, partial concordance, discordance, and missing. Risk factors for satisfaction were identified using a multivariable analysis.
Among 403 participants, 305 (78.2%; 95% confidence interval [CI], 73.8-82.1) were "very satisfied," and 358 of 399 (89.7%; 95% CI, 86.3-92.5) "would want the same anesthesia team." Full concordance occurred in 18 (4.5%) cases, partial concordance in 117 (29.0%), discordance in 175 (43.4%), and missing in 93 (23.1%). Satisfaction rate was 88.9% for full concordance, 71.8% for partial concordance, 81.1% for discordance, and 78.5% for missing ( P value = .202). In the multivariable analysis, there was insufficient evidence for an association of concordance with satisfaction. Compared to full concordance, partial concordance was associated with a nonsignificant 57% (95% CI, -113 to 91) decrease in the odds of being satisfied, discordance with a 29% (95% CI, -251 to 85) decrease, and missing with a 39% (95% CI, -210 to 88) decrease. Risk factors for not being "very satisfied" were PDCD, anxiety disorders, pregnancy resulting from in vitro fertilization, intravenous medication administration, intrapartum cesarean with extension of labor epidural, having 3 anesthesia team members (instead of 2), and a higher intraoperative blood loss.
Our inability to identify an association between concordance and satisfaction is likely due to the high satisfaction rate in our cohort (78.2%), combined with low proportion of full concordance (4.5%). Addressing elements such as PDCD, anxiety, intravenous medication administration, and use of epidural anesthesia for cesarean delivery, and a better understanding of the interplay between concordance and satisfaction are warranted.
患者和医疗保健提供者之间的种族和民族一致性会提高患者的满意度，但在产科麻醉护理中尚未得到检验。本研究评估了种族和民族一致性与剖宫产期间疼痛管理满意度之间的关联。
这是一项对接受椎管内麻醉行剖宫产术的患者队列进行的二次分析，评估了与疼痛管理相关的剖宫产满意度。使用以下调查问题在分娩后 48 小时内记录满意度：“总体而言，您对麻醉护理在剖宫产过程中的疼痛管理方面的满意度如何？”使用 5 分李克特量表，满意度定义为“非常满意”。还询问了患者：“如果您再次进行剖宫产，是否希望由同一麻醉团队进行麻醉？”暴露因素是患者与麻醉团队成员（主治医生与住院医师、注册麻醉师或研究员）之间的种族和民族一致性，分为完全一致、部分一致、不一致和缺失。使用多变量分析确定满意度的风险因素。
在 403 名参与者中，305 名（78.2%；95%置信区间[CI]，73.8-82.1）“非常满意”，358 名（399 名中的 89.7%；95% CI，86.3-92.5）“希望由同一麻醉团队进行麻醉”。完全一致的有 18 例（4.5%），部分一致的有 117 例（29.0%），不一致的有 175 例（43.4%），缺失的有 93 例（23.1%）。完全一致的满意度为 88.9%，部分一致的满意度为 71.8%，不一致的满意度为 81.1%，缺失的满意度为 78.5%（P 值=0.202）。多变量分析中，一致性与满意度之间的关联证据不足。与完全一致相比，部分一致与满意度降低的可能性降低了 57%（95% CI，-113 至 91），不一致与满意度降低的可能性降低了 29%（95% CI，-251 至 85），缺失与满意度降低的可能性降低了 39%（95% CI，-210 至 88）。满意度降低的风险因素包括剖宫产、焦虑障碍、体外受精导致的妊娠、静脉内药物管理、分娩时行剖宫产术且延长硬膜外麻醉、有 3 名麻醉团队成员（而非 2 名）以及术中出血量较高。
我们未能确定一致性与满意度之间的关联，这可能是由于我们队列中的高满意度（78.2%），再加上完全一致的比例较低（4.5%）所致。需要解决与剖宫产相关的疼痛管理、焦虑、静脉内药物管理以及硬膜外麻醉的使用等问题，还需要更好地理解一致性与满意度之间的相互作用。
