Uncovering Disparities in Anesthesia Care

Health disparities permeate all areas of healthcare, including surgical care and pain management. Assistant Professor Hideyo Tsumura, PhD’22, DNP, RN, CRNA, recently examined differences in providers’ use of medication between African American and non-Hispanic white patients during surgery where patients were under general anesthesia.

“While conducting a literature review, I observed that there is limited knowledge regarding disparities in intraoperative anesthesia care,” Tsumura said, noting that most of the research on inequity in peri-anesthesia care—that is, care before, during and after surgery—focused on epidural anesthesia in patients giving birth. Those studies found African Americans received a lower rate of epidural anesthesia for labor pains and C-sections than did their non-Hispanic white counterparts. “Similarly, African American patients are less likely to receive regional anesthesia for postoperative pain management following non-obstetric surgeries compared to non-Hispanic white patients,” Tsumura said.

Tsumura’s recent study sought to uncover more information about the use of anesthesia in other types of surgeries in these demographics. The study reviewed electronic health records of surgery patients at a large academic health system between January 2018 and August 2019, narrowing in on a sample of more than 31,000 patients, 74.1% non-Hispanic white, and 25.9% African American. One challenge of the study was the disparate sample sizes, Tsumura said, and subsequently they used a statistical method called inverse probability of treatment weighting (IPTW) to balance baseline characteristics between the groups, making the comparison feasible and valid.

The study found that non-Hispanic Black patients were significantly more likely to receive midazolam, a drug used to relax patients before surgery, as well as anti-hypertensive drugs. They were less likely to receive drugs to combat hypotension, a common side effect of anesthesia associated with detrimental complications. The study observed a difference in drugs used to manage blood pressure even when measurements were the same between the two demographics.

Despite differences in these specific areas, the study found that race was not a significant factor in the total dose of opioid analgesia or in the use of sugammadex, a drug used during surgery to reverse the neural block, Tsumura said.

The study, “Exploring Differences in Intraoperative Medication Use Between African American and Non-Hispanic White Patients During General Anesthesia: Retrospective Observational Cohort Study,” was published in May 2024.

While the study concluded that differences in providers’ use of peri-anesthesia drugs do exist among different demographic populations, more research is needed to further examine the effects of socioeconomic variables and clinician biases.

“Future research is needed to investigate mechanisms contributing to these differences as well as how these differences are associated with patient outcomes,” Tsumura said. “Given this exploratory study, our main aim is to raise clinicians' awareness about this critical healthcare issue.”

 Nurse scientists and researchers at Duke University School of Nursing are leading the charge to address healthcare challenges here in North Carolina and across the globe. Learn more by visiting our Center for Nursing Research. 

You can help support this vital research: Give to the School of Nursing's Annual Fund.