Applying a health equity lens to the perioperative anesthetic management for coronary artery bypass grafting

Chukwuma Azoba; Jonte D Jefferson; Ashley P Oliver; Emily Brennan; Mohanad R Youssef; Elizabeth B Habermann; Kristine T Hanson; David O Warner; Kristen Sell-Dottin; Adam J Milam

doi:10.1016/j.carrev.2024.10.005

Applying a health equity lens to the perioperative anesthetic management for coronary artery bypass grafting

Cardiovasc Revasc Med. 2024 Oct 29:S1553-8389(24)00702-4. doi: 10.1016/j.carrev.2024.10.005. Online ahead of print.

Authors

Affiliations

¹ Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85054, USA.
² Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA, 55905.
³ Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
⁴ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA.
⁵ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85054, USA.
⁶ Department of Cardiothoracic Surgery, Mayo Clinic, Phoenix, 85054, USA.
⁷ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Phoenix, AZ 85054, USA. Electronic address: milam.adam@mayo.edu.

PMID: 39516128
DOI: 10.1016/j.carrev.2024.10.005

Abstract

Background: Disparities in healthcare based on race, ethnicity, and socioeconomic status (SES) remain a public health crisis, especially in perioperative anesthetic management. This study applies a health equity lens to intraoperative pain and postoperative nausea and vomiting (PONV) for patients undergoing coronary artery bypass grafting (CABG).

Methods: This retrospective cohort study included 1404 adult patients who underwent coronary artery bypass grafting (CABG) between 2017 and 2022 at a single, multi-site, academic healthcare system. The primary outcomes were PONV as well as moderate-to-severe post-operative pain. Secondary outcomes were administration of prophylactic antiemetics, compliance with guideline-recommended antiemetic prophylaxis, and opioid morphine milligram equivalents (MME) administered intraoperatively. Independent variables included patient race and ethnicity, healthcare payor type, and community-level SES (using Area Deprivation Index [ADI]). Multivariable logistic regression models that controlled for relevant covariates were utilized.

Results: The findings showed no significant disparities in experiencing PONV, post-operative pain, or receiving high opioid MME based on race, ethnicity, payor type, and ADI. There were also no differences in the receipt of antiemetics nor compliance with guideline-recommended antiemetic prophylaxis.

Conclusions: Our study did not find racial, ethnic, or SES disparities in intraoperative anesthetic pain management, postoperative pain, nor PONV management. Applying a health equity lens to quality outcomes during the perioperative period is necessary to ensure equitable care among diverse populations.

Keywords: Cardiac surgery; Coronary artery bypass graft; Postoperative nausea and vomiting; Postoperative pain management; Racial disparity; Socioeconomic status.