title: Anesthetic Care for Orthopedic Patients: Is There a Potential for Differences in Care?
abstract: BACKGROUND
  Differences in health care represent a major health policy issue. Despite increasing evidence on the mediating role of anesthesia type used for surgery on perioperative outcome, there is a lack of data on potential care differences in this field. The authors aimed to determine whether anesthesia practice (use of neuraxial anesthesia [NA] or peripheral nerve block [PNB]) differs by patient and hospital factors.
  
  
  METHODS
  The authors extracted data on n = 1,062,152 hip and knee arthroplasty procedures from the Premier Perspective database (2006 to 2013). Multilevel multivariable logistic regression models measured associations (odds ratios [ORs] and 95% CIs) between patient/hospital factors and NA or PNB use.
  
  
  RESULTS
  Of all patients, 22.2% (n = 236,083) received NA and 17.9% (n = 189,732) received PNB. Lower adjusted odds for receiving NA were seen for black patients (OR, 0.88; 95% CI, 0.86 to 0.91) and those on Medicaid (OR, 0.78; 95% CI, 0.74 to 0.82) or without insurance (OR, 0.89; 95% CI, 0.81 to 0.98). Furthermore, teaching hospitals (compared with nonteaching hospitals) had lower adjusted odds for NA utilization (OR, 0.35; 95% CI, 0.14 to 0.89). Although generally similar patterns were seen for PNB utilization, the main difference was that particularly Hispanic patients were less likely to receive PNB compared with white patients (OR, 0.60; 95% CI, 0.56 to 0.65). Sensitivity analyses generally validated our results.
  
  
  CONCLUSIONS
  Significant differences exist in the provision of regional anesthetic care with factors such as race and insurance type being important determinants of anesthetic practice. Further and in-depth research is needed to fully assess the background of these differences.
authors.affiliation: From the Department of Anesthesiology, Hospital for Special Surgery, New York, New York (S.G.M., M.O.); and Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York (J.P., N.Z., R.R., M.M.).
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.forename: Jashvant
authors.initials: J
authors.lastname: Poeran
authors.forename: Nicole
authors.initials: N
authors.lastname: Zubizarreta
authors.forename: Rehana
authors.initials: R
authors.lastname: Rasul
authors.forename: Mathias
authors.initials: M
authors.lastname: Opperer
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
mesh_terms: D000765:Anesthesia, Conduction / Q000191:economics* / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000379:methods; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D019637:Orthopedic Procedures / Q000191:economics* / Q000379:methods; D044469:Racial Groups / Q000208:ethnology