Neuraxial catheter placement alleviates racial, ethnic disparities in cesarean delivery

Key takeaways:

• A total of 82.1% of women undergoing cesarean delivery received neuraxial labor analgesia in situ.
• General anesthesia rates were no different from neuraxial analgesia rates for racial/ethnic groups.

There were no racial or ethnic disparities linked to neuraxial catheter placement for women undergoing cesarean delivery, despite disparities in general anesthesia rates continuing to exist, researchers reported in JAMA Network Open.

“Non-Hispanic Black and Hispanic patients have higher odds of undergoing general anesthesia for cesarean delivery compared with non-Hispanic white patients,” Caroline Leigh Thomas, MD, an anesthesiology specialist in the department of anesthesiology and critical care at the University of Chicago Medical Center, and colleagues wrote. “There is a paucity of literature addressing why this disparity exists, and most studies evaluating racial and ethnic disparities in anesthetic techniques for cesarean delivery have been performed on a population level, lacking granularity.”

Thomas and colleagues conducted a retrospective, cross-sectional, single-center study with data from 35,117 women (median age, 33 years) who underwent cesarean delivery at Northwestern Medicine’s Prentice Women’s Hospital from 2007 to March 2018. Researchers collected data on maternal demographics, clinical characteristics, obstetric and anesthetic data, cesarean delivery indications and general anesthesia indications.

The primary outcome was the rate of general anesthesia for women undergoing cesarean delivery by race and ethnicity.

Overall, 3.3% of women received general anesthesia (2.5% Asian; 5% Black; 3.7% Hispanic; 2.8% white; and 3.8% other racial/ethnic groups).

A total of 56.8% of women were in labor at the time of their cesarean delivery. Of these women, 82.1% received neuraxial labor analgesia in situ. Of women who received an epidural catheter in situ, researchers observed no racial or ethnic differences in general anesthesia use rates compared with neuraxial analgesia use for Asian (6.8% vs. 8.1%), Black (15.5% vs. 12.1%), Hispanic (15.9% vs. 15.2%), white (50.7% vs. 52.2%) and those of other races/ethnicities (11.1% vs. 12.3%), respectively.

Researchers noted that cesarean delivery and general anesthesia indications were not different when stratified by race and ethnicity.

“Future studies are needed to further elucidate the cause of the discrepancy in the administration of general anesthesia and neuraxial analgesia and strategies to eliminate it,” the researchers wrote. “Attention should focus on patient-centered, timely administration of neuraxial labor analgesia and on identifying actionable items among patients without epidural labor analgesia.”