49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Disparities In Neuraxial Anesthesia Administration Based on Primary Spoken Language of Hip Fracture Patients

PRESENTER:

Jashvant Poeran, MD PhD

BACKGROUND:

•Disparities related to race/ethnicity, insurance status, and other socioeconomic factors have been documented across all areas of medicine, including various orthopedic subspecialities in terms of care processes and outcomes

•Limited research exists examining the role of primary spoken language in perioperative processes across orthopedic surgery

•Our group has previously described differences in the receipt of neuraxial (NA) versus general anesthesia among total joint arthroplasty recipients

•Our objective is to determine if patients’ primary spoken language (English versus non-English) is associated with odds of receiving NA versus general anesthesia among surgical hip fracture cases

METHODS

Design: Retrospective Cohort Study

Data Set: 2016 – 2023 Mount Sinai health system database

Surgical subtypes:

•Total hip arthroplasty

•Partial hip arthroplasty

•Open reduction internal fixation

•Closed reduction percutaneous pinning

Variables: Primary spoken language was categorized

as: English, Spanish, and other non-English.

Statistical Analysis: Mixed-effects logistic regression evaluated the association between patients’ primary spoken language and NA (versus general anesthesia) use, adjusting for sociodemographic and clinical factors. We report adjusted odds ratios (OR) and 95% confidence intervals (CIs). Statistical significance is determined at p<.05

In contrast to our findings in an elective joint arthroplasty cohort, patients’ primary spoken language was not associated with neuraxial anesthesia receipt in this non-elective cohort.

Figure 1. ORs for the association between type of anesthesia (neuraxial vs. general) and primary spoken language. OR for sensitivity analysis shown (bottom), in which Spanish and other subgroups are pooled and compared to English group. Adjusted for age, sex, race/ethnicity, insurance type, procedure type (CRPP, ORIF/IM, THA Hemiarthroplasty), fracture type (intracapsular/extracapsular), American Society of Anesthesiologists physical status classification score, Charlson comorbidity index, obesity, dementia and smoker status

Table 1. Patient characteristics (abbreviated) including gender, race, hospital, ), American Society of Anesthesiologists physical status, and Neuraxial anesthesia use

REFERENCES

1.Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458-1460. doi:10.1016/j.injury.2018.04.015

2.Tzimas P, Samara E, Petrou A, Korompilias A, Chalkias A, Papadopoulos G. The influence of anesthetic techniques on postoperative cognitive function in elderly patients undergoing hip fracture surgery: General vs spinal anesthesia. Injury. 2018;49(12):2221-2226. doi:10.1016/j.injury.2018.09.023

3.Li T, Li J, Yuan L, et al. Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial [published correction appears in JAMA. 2022 Mar 22;327(12):1188]. JAMA. 2022;327(1):50-58. doi:10.1001/jama.2021.22647

4.Neuman MD, Feng R, Carson JL, et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021;385(22):2025-2035. doi:10.1056/NEJMoa2113514

5.Morris MT, Morris J, Wallace C, et al. An Analysis of the Cost-Effectiveness of Spinal Versus General Anesthesia for Lumbar Spine Surgery in Various Hospital Settings. Global Spine J. 2019;9(4):368-374. doi:10.1177/2192568218795867

6.Sowers M, Jacob R, Chandler K, et al. Operative room time comparison between general and spinal anesthesia in total hip arthroplasty: an institutional study [published online ahead of print, 2023 Jan 25]. Arch Orthop Trauma Surg. 2023;10.1007/s00402-023-04775-4. doi:10.1007/s00402-023-04775-4

7.Hwang SM, Lee JJ, Jang JS, Gim GH, Kim MC, Lim SY. Patient preference and satisfaction with their involvement in the selection of an anesthetic method for surgery. J Korean Med Sci. 2014;29(2):287-291. doi:10.3346/jkms.2014.29.2.287

8.Shapeton A, O'Donoghue M, VanderWielen B, Barnett SR. Anesthesia Lost in Translation: Perspective and Comprehension. J Educ Perioper Med. 2017;19(1):E505. Published 2017 Jul 1.

Charles Laurore BA/MS1, Avanish Yendluri BS1, Mateo Restrepo Mejia BS1, Brocha Stern PhD1, Chang Park MD2, Garrett Burnett MD2, Jashvant Poeran MD/PhD1, David Forsh MD1

1 Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA

2 Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA

49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

DISPARITIES IN NEURAXIAL ANESTHESIA ADMINISTRATION BASED ON PRIMARY SPOKEN LANGUAGE OF HIP FRACTURE PATIENTS

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