Language-Related Disparities in Pain Management in the Post-Anesthesia Care Unit for Children Undergoing Laparoscopic Appendectomy.

Marla Ferschl,Solmaz P. Manuel,Holly Elser,Anjali A. Dixit,Catherine L. Chen

doi:10.3390/children7100163

Abstract

Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language proficiency influenced pain management in the post-anesthesia care unit (PACU) in a cohort of children who underwent laparoscopic appendectomy at our pediatric hospital in San Francisco. Our primary exposure was English language proficiency, and our primary outcome was administration of any opioid medication in the PACU. Secondary outcomes included the amount of opioid administered in the PACU and whether any pain score was recorded during the patient’s recovery period. Statistical analysis included adjusting for demographic covariates including race in estimating the effect of language proficiency on these outcomes. In our cohort of 257 pediatric patients, 57 (22.2%) had low English proficiency (LEP). While LEP and English proficient (EP) patients received the same amount of opioid medication intraoperatively, in multivariable analysis, LEP patients had more than double the odds of receiving any opioid in the PACU (OR 2.45, 95% CI 1.22–4.92). LEP patients received more oral morphine equivalents (OME) than EP patients (1.64 OME/kg, CI 0.67–3.84), and they also had almost double the odds of having no pain score recorded during their PACU recovery period (OR 1.93, CI 0.79–4.73), although the precision of these estimates was limited by small sample size. Subgroup analysis showed that children over the age of 5 years, who were presumably more verbal and would therefore undergo verbal pain assessments, had over triple the odds of having no recorded pain score (OR 3.23, CI 1.48–7.06). In summary, English language proficiency may affect the management of children’s pain in the perioperative setting. The etiology of this language-related disparity is likely multifactorial and should be investigated further.

Highlights

Disparities in pediatric pain management associated with race/ethnicity are well-documented.In emergency departments nationwide, Black children receive opioids at significantly lower rates thanWhite children when presenting with acute appendicitis [1]
The most common language spoken by low English proficiency (LEP) patients was Spanish (80.7%)
LEP patients were more likely to select “Other” as their race (87.7% compared to 41.5%) and to select any non-White race (91.2% compared to 53.5%)

Summary

Introduction

Disparities in pediatric pain management associated with race/ethnicity are well-documented.In emergency departments nationwide, Black children receive opioids at significantly lower rates thanWhite children when presenting with acute appendicitis [1]. White children are more likely than non-White children to receive opioid prescriptions for pain management [2]. Children 2020, 7, 163 colleagues found that children of Latin American descent receive opioids in the post-anesthesia care unit (PACU) at lower rates following tonsillectomy and adenoidectomy [3]. English language proficiency, which may be correlated with race/ethnicity [6,7], is less frequently considered in the study of health disparities among children. Non-White adults who are not proficient in English are less likely to receive empathy, establish rapport, benefit from adequate communication, and be involved in shared decision-making with their physicians [7]. Parents of children whose primary language is not English are more likely to be dissatisfied with the amount of time and quality of care provided by their children’s clinicians [9]

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