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ANALGESIA

The Influence of Race and Socioeconomic Factors on Patient Acceptance of Perioperative Epidural Analgesia

Edward Andrew Ochroch, MD, MSCE^*, Andrea B. Troxel, ScD, Jonathan K. Frogel, MD, and John T. Farrar, MD, PhD

From the *Department of Anesthesiology and Critical Care, University of Pennsylvania Health System; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania; Henry Ford Hospital, Detroit, Michigan; and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Pennsylvania.

Address correspondence to E. Andrew Ochroch, MD, MSCE, Department of Anesthesiology and Critical Care, 680 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104. Address e-mail to ochrocha{at}uphs.upenn.edu.

Abstract

BACKGROUND: Ethnic minorities and patients of lower socioeconomic status may be more averse to the acceptance of epidural analgesia than nonminority counterparts and those of higher socioeconomic status, despite evidence for substantial benefit to the patient.

METHODS: A scripted telephone survey was developed from the 2000 United States Census by a panel of experts. Contact was attempted at least twice for all patients listed for surgery at the Hospital of the University of Pennsylvania over a 4-mo period.

RESULTS: Three thousand seven hundred thirty-nine patients were called and 1265 subjects were successfully contacted and 1193 consented, whereas 72 refused to participate. Seven hundred sixty-two subjects (64%) would accept an epidural if recommended by an anesthesiologist and 425 (36%) would refuse. If the epidural was recommended by both the anesthesiologist and surgeon acceptance increased to 932 (78.5%). The univariate predictor of refusal of perioperative epidural analgesia was African American race. Univariate predictors of acceptance include full- or part-time employment, total household income >$50,001/yr, college graduate, prior epidural treatment, and knowledge of what an epidural is. When the potential confounders of race, total household income, employment, and education were included in a multivariate logistic regression model, African American race predicted refusal (odds ratio [OR], 0.58; P < 0.006; confidence interval [CI], 0.41–0.81) and was the only factor that predicted refusal or acceptance of epidural analgesia.

CONCLUSIONS: Acceptance of perioperative epidural analgesia is strongly affected by race and socioeconomic status. Anesthesiologists need to recognize this potential barrier when trying to maximize patient comfort and outcome.

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