Medicaid Patients, Minorities Less Likely To Receive Regional Anesthesia

Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY

Dr. Jashvant Poeran

MedicalResearch.com Interview with:
Jashvant Poeran MD PhD
Assistant Professor
Dept. of Population Health Science & Policy
Icahn School of Medicine at Mount Sinai
New York, NY

Medical Research: What is the background for this study?

Dr. Poeran: Neuraxial anesthesia and peripheral nerve blocks  are two techniques for regional anesthesia for hip and knee replacements. Compared to general anesthesia, these two regional anesthesia techniques are increasingly seen as ‘higher quality care’ as a growing number of studies show that patients have better outcomes after surgery when regional anesthesia is used. However, less is known about the factors that influence the process of anesthetic care. This is important information because the choice for regional anesthesia might affect outcomes after hip and knee replacement surgery. We therefore used a large national database of health claims of hip and knee replacement procedures to study if specific patient subgroups were less likely to receive regional anesthesia.

Medical Research: What are the main findings?

Dr. Poeran: Among >1 million hip and knee replacement procedures we found that specific patient subgroups –particularly Black and Hispanic patients and those on Medicaid or with no insurance- are up to 40% less likely to receive regional anesthesia.

Medical Research: What should clinicians and patients take away from your report?

Dr. Poeran: This is one of the first studies using national data looking into differences in anesthetic care for patients undergoing hip and knee replacements. There still is a lack of studies on what factors drive the decision for regional anesthesia. These could be manifold: patient, but also physician preferences, local hospital policies, or other factors such as underlying diseases or medication use. Given that increasing evidence points towards regional anesthesia to be preferred over general anesthesia in these procedures, it remains important for particularly patients to remain engaged in decision making in all aspects of their care, including anesthesia care during a hip and knee replacement. The important message for clinicians and researchers is the call for additional studies on drivers of the choice for regional anesthesia since this appears to be linked to patient outcomes after surgery.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Poeran: Validation of the current results using other data sources (other national databases) and a thorough assessment of factors that affect the decision-making process in the provision of regional anesthetic techniques. This would provide additional insight into what data is needed to appraise the observed differences in provision of anesthetic care.

Citation:

ANESTHESIOLOGY® 2015 abstract discussing: 

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Jashvant Poeran MD PhD (2015). Medicaid, Minorities Less Likely To Receive Regional Anesthesia