Abstract
BackgroundThe impact of patient ethnicity on healthcare delivery is well documented. In this study of children who had undergone open abdominal or pelvic surgery for tumor resection, we sought to compare the use of epidural analgesia or intraoperative blood transfusions between Caucasian and non-Caucasian children.MethodsA retrospective study of 139 children was performed. Logistic regression models were used to evaluate the association between the specified perioperative factors and patient ethnicity.ResultsThe average age (standard deviation) was 11 years (± 5), 50% were female, and 58% were Caucasian. Compared to Caucasian children, non-Caucasian children were younger (difference in mean, − 2.6 years; 95% confidence interval [− 4.3, − 0.9], p = 0.003), underwent shorter procedures (difference in mean anesthesia minutes, − 134; 95% confidence interval [− 230, − 39], p = 0.006), and had a lower proportion of patients who received epidural analgesia (66% versus 81%, p = 0.042) or blood transfusions (48% versus 65%, p = 0.039). In the adjusted model, patient ethnicity was not associated with the receipt of epidural analgesia (odds ratio 0.53, 95% confidence interval [0.23, 1.21], p = 0.132) or blood transfusions (odds ratio 0.77, 95% confidence interval [0.29, 2.04], p = 0.600). The use of epidural analgesia or blood transfusions was associated with abnormal coagulation factors (odds ratio 0.32, 95% confidence interval [0.14, 0.71], p = 0.005) and the duration of surgery (odds ratio 1.007, 95% confidence interval [1.005, 1.009], p < 0.001), respectively.ConclusionIn this study of children who had undergone major oncologic surgery, the use of epidural analgesia or blood transfusions was not associated with patient ethnicity.
Highlights
The impact of patient ethnicity on healthcare delivery is well documented
Based on the results of previous studies (Ochroch et al, 2007; Orejuela et al, 2012; Maher et al, 2018; Qian et al, 2014), we hypothesized that compared to Caucasian children, non-Caucasian children would have a lesser likelihood of receiving epidural analgesia and have higher rates of blood transfusion
Baseline characteristics of Caucasian and non-Caucasian patients Compared to Caucasian children, non-Caucasian children were younger (difference in mean − 2.6 years, 95% confidence interval [− 4.3, − 0.9] and were less likely to be on prescription opioids preoperatively (12% versus 33%, p = 0.005)
Summary
In this study of children who had undergone open abdominal or pelvic surgery for tumor resection, we sought to compare the use of epidural analgesia or intraoperative blood transfusions between Caucasian and non-Caucasian children. Identification of ethnic-based differences in care delivery within a practice setting could potentially provide an opportunity for quality improvement Based on this premise, we conducted a retrospective study of children and adolescents who had undergone open abdominal or pelvic tumor resection by a single surgeon. Our primary objective was to determine whether there were any ethnic-based differences in the use of epidural analgesia or in intraoperative blood transfusions between Caucasian and non-Caucasian children. Based on the results of previous studies (Ochroch et al, 2007; Orejuela et al, 2012; Maher et al, 2018; Qian et al, 2014), we hypothesized that compared to Caucasian children, non-Caucasian children would have a lesser likelihood of receiving epidural analgesia and have higher rates of blood transfusion
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