Racial, ethnic disparities evident in administration of postdural puncture headache

April 27, 2022

2 min learn

Disclosures:
Lee experiences no related monetary disclosures. Please see the examine for all the opposite authors’ related monetary disclosures.


A cross-sectional examine printed in JAMA Community Open revealed important racial and ethnic disparities within the administration of postdural puncture headache utilizing epidural blood patches, which can be related to long-term adversarial results.

“Racial and ethnic disparities in maternal well being care outcomes have been properly documented, however there was little analysis relating to disparities particularly associated to obstetric anesthesia care,” Allison Lee, MD, MS, an affiliate professor of anesthesiology at Columbia College Irving Medical Middle (CUIMC) in New York Metropolis, instructed Healio. “With respect to minority — in contrast with white — birthing individuals, we already had proof of:

Data derived from Lee A, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.8520.
Information derived from Lee A, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.8520.
  • decrease labor epidural charges, regardless of it being the simplest modality for ache aid;
  • increased charges of basic anesthesia for cesarean deliveries, which is related to higher dangers and issues; and
  • worse management of pain after cesarean delivery.

“Primarily based on these prior experiences and given the significance of efficient administration of postdural puncture headache (due to recognized issues if untreated), we hypothesized that comparable patterns with respect to inferior administration of postdural puncture headache amongst minority ladies could be noticed,” stated Lee, who can also be the medical director of the Margaret Wooden Middle for Simulation and Schooling at CUIMC.

Lee and colleagues analyzed knowledge from the State Inpatient Database for New York and decided the components related to inequities that could be conceptualized on the stage of the affected person, clinician, medical encounter and well being care system.

Of 8,921 sufferers (imply age, 30 years; 55.6% white) with postdural puncture headache (PDPH), 47% acquired an epidural blood patch (EBP). Sufferers who acquired an EBP have been extra more likely to have non-public medical insurance and endure a vaginal supply in contrast with sufferers who didn’t obtain an EBP.

Though 53.4% (n = 2,650) of white sufferers with PDPH acquired an EBP, this fee was considerably decrease for Hispanic sufferers (41.7%), Black sufferers (35.7%) and sufferers of different race and ethnicity (35.2%).

Allison Lee, MD, MS

Allison Lee

“Racial disparities exist with respect to the best way postdural puncture headache is being managed amongst minority birthing individuals,” Lee stated. “Anesthesia suppliers should systematically assess for headache postpartum and handle promptly.”

Earlier analysis established that solely 50% of Black sufferers and 35% of Hispanic sufferers used neuraxial labor analgesia in contrast with 60% of white sufferers, regardless of neuraxial labor analgesia being the simplest and protected type of analgesia obtainable for labor and supply for each moms and newborns, the researchers famous.

“Given the disparities which have been highlighted, we want to higher perceive what interventions are only to deal with them,” Lee stated. “Researchers ought to then examine the outcomes of such initiatives, to find out the simplest options.”

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