Hispanic, Medicaid patients less likely to receive regional anesthesia during hip and knee replacement surgery

Patients who are black, Hispanic, on Medicaid or are uninsured may be less likely to receive regional anesthesia during hip and knee replacement surgery, possibly putting them at greater risk of serious complications, according to a study of more than 1 million orthopedic surgeries being presented at the ANESTHESIOLOGY® 2015 annual meeting.

"There is increasing evidence that regional anesthesia could reduce the risk of death and blood clots, compared to general anesthesia, during hip and knee replacement surgery," said Jashvant Poeran, M.D., Ph.D., assistant professor in the Department of Population Health Science & Policy at the Icahn School of Medicine at Mount Sinai, New York. "Specific patient groups are significantly less likely to receive regional anesthesia, and this disparity may have a negative impact on their outcomes."

In the study, researchers looked at anesthesia data on 1,062,152 hip and knee replacement surgeries between 2006 and 2013 from a national claims database. The researchers specifically focused on regional anesthesia: either neuraxial anesthesia (which includes spinal blocks and epidurals) or peripheral nerve blocks. Twenty-two percent of patients had neuraxial anesthesia, 18 percent had a peripheral nerve block, while the rest received general anesthesia. Hispanic patients were 24 percent less likely, Medicaid patients 20 percent less likely, uninsured patients 16 percent less likely, and black patients 10 percent less likely to receive either form of regional anesthesia.

"This study adds to the evidence that unjustifiable factors such as race or insurance type can potentially affect care," said Dr. Poeran. "We also found hospital factors to play a role, suggesting a patient's likelihood of receiving regional anesthesia is tied to the hospital where care was received."

Although there is no clear reason why these disparities exist, studies show similar inequalities exist in other areas of health care, such as suboptimal care of black men with prostate cancer and poor prenatal care for women from low socioeconomic backgrounds.