At the Intersection of DEI and Anesthesiology

In 2018, we began taking intentional steps to facilitate discussions and employ strategies to ensure that our volunteers and board leaders represent our diplomates and candidates. This work has become part of a broader strategy to weave diversity, equity and inclusion (DEI) into the fabric of the ABA culture. If you have reviewed our recent survey results from our DEI survey deployed to volunteers, diplomates and ABA staff in 2021, you may be curious about our reasoning behind developing DEI at the ABA. So here we are to address the crucial question of “but why?”

We recognize that the ABA plays a distinct role in addressing biases that endanger healthcare outcomes and advancing equity and inclusion. We are also aware that healthcare research, quality metrics and the needs of patients tell us we could do better. A growing body of evidence shows a gap in health outcomes and quality of care for patients based on race and socioeconomic status. 

Looking broadly at anesthesia care and race, according to Memtsoudis, et al., “Black, Native American, Asian, and Pacific Islander patients were more than twice as likely to have general anesthesia than regional anesthesia.”1 It would be impossible to ignore the correlation between race and care decisions. This reality makes it necessary for the ABA to provide increased awareness of the inequalities that can impact patient safety. 

In addition, Andreae et al. found that anesthesiologists administered fewer antiemetics to patients with lower socioeconomic status.2 This may be an indicator that socioeconomic status contributes not only to inferior care but diminishes positive patient outcomes and discourages trust between patients and their physicians. While assumptions can be made or correlations hypothesized, data shows us that inequalities exist that endanger healthcare outcomes. 

There have been significant findings regarding minority women and childbirth, which is not only a topic amongst anesthesiologists but a mainstream media discussion that requires further understanding and attention. Neuraxial labor analgesia, including epidural or combined spinal-epidural analgesia, is the most effective treatment modality for the severe pain associated with childbirth.Both the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Anesthesiologists (ASA) have promoted the use of neuraxial analgesia due to its adaptability, efficacy and minimal effects on the neonate.4 However, evidence indicates that inequalities in care and offerings vary based on race. 

In the US, 60% of obstetric patients use neuraxial labor analgesia for pain control5; however, Black and Hispanic women are less likely to receive neuraxial labor analgesia than non-Hispanic white women.6-8 This finding has persisted across multiple studies, which have controlled for patient-level factors such as age and clinical resources, including the availability of anesthesiologists in the area.6 This supports that racial inequities and biases are not rare occurrences but integrated into our health systems nationwide. 

Awareness of health disparities further protects patients and physicians. Providing awareness of these topics begins the change process required in healthcare to address health disparities that endanger patient outcomes. Learn more about how the ABA is addressing these concerns by making necessary changes to incorporate DEI topics into our assessments and continuing education programs.  

ABA RESOURCES: 

REFERENCES:

  1. Memtsoudis SG, Besculides MC, Swamidoss CP. Do race, gender, and source of payment impact on anesthetic technique for inguinal hernia repair? Journal of Clinical Anesthesia. 2006;18(5):328-333. doi:10.1016/j.jclinane.2005.08.006
  2. Andreae MH, Gabry JS, Goodrich B, White RS, Hall C. Antiemetic Prophylaxis as a Marker of Health Care Disparities in the National Anesthesia Clinical Outcomes Registry. Anesthesia & Analgesia. 2018;126(2):588-599. doi:10.1213/ane.0000000000002582
  3. Mhyre JM, Sultan P. General Anesthesia for Cesarean Delivery. Anesthesiology. 2019;130(6):864-866. doi:10.1097/aln.0000000000002708
  4. ACOG Practice Bulletin No. 209. Obstetrics & Gynecology. 2019;133(3):e208-e225. doi:10.1097/aog.0000000000003132
  5. Osterman MJ, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. Natl Vital Stat Rep. 2011;59(5):1-16.
  6. Rust G, Nembhard WN, Nichols M, et al. Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery. American Journal of Obstetrics and Gynecology. 2004;191(2):456-462. doi:10.1016/j.ajog.2004.03.005
  7. Glance LG, Wissler R ., Glantz C, Osler TM, Mukamel DB, Dick AW. Racial Differences in the Use of Epidural Analgesia for Labor. Anesthesiology. 2007;106(1):19-25. doi:10.1097/00000542-200701000-00008
  8. Toledo P, Sun J, Grobman WA, Wong C, Feinglass J, Hasnain-Wynia R. Racial and Ethnic Disparities in Neuraxial Labor Analgesia. Survey of Anesthesiology. 2012;56(4):181-182. doi:10.1097/01.sa.0000415538.74078.50