Potnuru Paul P, Jonna Srikar, Orlando Barbara, Nwokolo Omonele O
From the Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas.
Anesth Analg. 2024 Dec 1;139(6):1190-1198. doi: 10.1213/ANE.0000000000006754. Epub 2024 Nov 15.
Racial and ethnic disparities in health care delivery can lead to inadequate peripartum pain management and associated adverse maternal outcomes. An epidural blood patch (EBP) is the definitive treatment for moderate to severe postdural puncture headache (PDPH), a potentially debilitating neuraxial anesthesia complication associated with significant maternal morbidity if undertreated. In this nationwide study, we examine the racial and ethnic disparities in the inpatient utilization of EBP after obstetric PDPH in the United States.
In this retrospective observational study, we used the National Inpatient Sample, a nationally representative database of discharge records for inpatient admissions in the United States, from 2016 to 2020. We analyzed delivery hospitalizations of women of childbearing age (15-49 years) diagnosed with PDPH. Adjusting for maternal and hospitalization characteristics as confounders, we used a multilevel mixed-effects logistic regression model to compare the rates of EBP utilization by race and ethnicity. Secondarily, among hospitalizations with an EBP, we examined the association between race and ethnicity and the timing of the EBP procedure.
We analyzed 49,300 delivery hospitalizations with a diagnosis of PDPH. An EBP was performed in 24,075 (48.8%; 95% confidence interval [CI], 47.8%-49.9%) of these hospitalizations. EBP was performed in 52.7% (95% CI, 51.3%-54.1%) of White non-Hispanic patients with PDPH. Compared to White non-Hispanic patients, Black non-Hispanic (adjusted odds ratio [aOR] = 0.69; 99% CI, 0.56-0.84), Hispanic (aOR = 0.80, 99% CI, 0.68-0.95), and Asian or Pacific Islander patients (aOR = 0.74, 99% CI, 0.58-0.96) were less likely to receive an EBP. The median (interquartile range [IQR]) time to perform an EBP was 2 (1-3) days after admission, with 90% of EBP procedures completed within 4 days of admission. There was no significant association between race and ethnicity and the timing of EBP placement.
In this nationwide analysis of delivery hospitalizations from 2016 to 2020 in the United States with a diagnosis of PDPH, we identified racial and ethnic disparities in the utilization of EBP. Minoritized patients identified as Black non-Hispanic, Hispanic, or Asian or Pacific Islander were less likely to receive an EBP for the treatment of PDPH compared to White non-Hispanic patients. Suboptimal treatment of PDPH may be associated with adverse long-term outcomes such as postpartum depression, posttraumatic stress disorder, and chronic headaches. Racial and ethnic disparities in EBP utilization should be further investigated to ensure equitable health care delivery.
医疗服务中的种族和民族差异可能导致围产期疼痛管理不足以及相关的不良孕产妇结局。硬膜外血贴（EBP）是治疗中度至重度硬膜外穿刺后头痛（PDPH）的决定性方法，PDPH是一种潜在的使人衰弱的神经轴麻醉并发症，如果治疗不充分会导致显著的孕产妇发病。在这项全国性研究中，我们调查了美国产科PDPH后住院患者使用EBP的种族和民族差异。
在这项回顾性观察研究中，我们使用了国家住院患者样本，这是一个具有全国代表性的美国2016年至2020年住院出院记录数据库。我们分析了诊断为PDPH的育龄妇女（15 - 49岁）的分娩住院情况。将孕产妇和住院特征作为混杂因素进行调整后，我们使用多水平混合效应逻辑回归模型比较不同种族和民族的EBP使用率。其次，在接受EBP的住院患者中，我们研究了种族和民族与EBP操作时间之间的关联。
我们分析了49300例诊断为PDPH的分娩住院病例。其中24075例（48.8%；95%置信区间[CI]，47.8% - 49.9%）进行了EBP。患有PDPH的非西班牙裔白人患者中52.7%（95% CI，51.3% - 54.1%）进行了EBP。与非西班牙裔白人患者相比，非西班牙裔黑人（调整后的优势比[aOR] = 0.69；99% CI，0.56 - 0.84）、西班牙裔（aOR = 0.80，99% CI，0.68 - 0.95）以及亚洲或太平洋岛民患者（aOR = 0.74，99% CI，0.58 - 0.96）接受EBP的可能性较小。进行EBP的中位（四分位间距[IQR]）时间为入院后2（1 - 3）天，90%的EBP操作在入院后4天内完成。种族和民族与EBP放置时间之间没有显著关联。
在这项对2016年至2020年美国诊断为PDPH的分娩住院病例的全国性分析中，我们发现了EBP使用方面的种族和民族差异。与非西班牙裔白人患者相比，被认定为非西班牙裔黑人、西班牙裔或亚洲或太平洋岛民的少数族裔患者接受EBP治疗PDPH的可能性较小。PDPH治疗不充分可能与产后抑郁、创伤后应激障碍和慢性头痛等不良长期结局相关。应进一步调查EBP使用中的种族和民族差异，以确保公平的医疗服务提供。
