Racial, ethnic disparities evident in management of postdural puncture headache

A cross-sectional study published in JAMA Network Open revealed significant racial and ethnic disparities in the management of postdural puncture headache using epidural blood patches, which may be associated with long-term adverse effects.

“Racial and ethnic disparities in maternal health care outcomes have been well documented, but there has been little research regarding disparities specifically related to obstetric anesthesia care,” Allison Lee, MD, MS, an associate professor of anesthesiology at Columbia University Irving Medical Center (CUIMC) in New York City, told Healio. “With respect to minority — compared with white — birthing people, we already had evidence of:

• lower labor epidural rates, despite it being the most effective modality for pain relief;
• higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications; and
• worse management of pain after cesarean delivery.

“Based on these prior reports and given the importance of effective management of postdural puncture headache (because of known complications if untreated), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed,” said Lee, who is also the medical director of the Margaret Wood Center for Simulation and Education at CUIMC.

Lee and colleagues analyzed data from the State Inpatient Database for New York and determined the factors associated with inequities that may be conceptualized at the level of the patient, clinician, clinical encounter and health care system.

Of 8,921 patients (mean age, 30 years; 55.6% white) with postdural puncture headache (PDPH), 47% received an epidural blood patch (EBP). Patients who received an EBP were more likely to have private health insurance and undergo a vaginal delivery compared with patients who did not receive an EBP.

Although 53.4% (n = 2,650) of white patients with PDPH received an EBP, this rate was significantly lower for Hispanic patients (41.7%), Black patients (35.7%) and patients of other race and ethnicity (35.2%).

Allison Lee

“Racial disparities exist with respect to the way postdural puncture headache is being managed among minority birthing people,” Lee said. “Anesthesia providers must systematically assess for headache postpartum and manage promptly.”

Previous research established that only 50% of Black patients and 35% of Hispanic patients used neuraxial labor analgesia compared with 60% of white patients, despite neuraxial labor analgesia being the most effective and safe form of analgesia available for labor and delivery for both mothers and newborns, the researchers noted.

“Given the disparities that have been highlighted, we would like to better understand what interventions are most effective to address them,” Lee said. “Researchers should then study the outcomes of such initiatives, to determine the most effective solutions.”

References:

• Guglielminotti J, et al. Anesthesiology. 2019;doi:10.1097/ALN.0000000000002629.
• Guglielminotti J, et al. Anesth Analg. 2019;doi:0.1213/ANE.0000000000004336.