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22-02-2024 | Nerve Block | Reconstructive Oncology

Reducing Disparities: Regional Anesthesia Blocks for Mastectomy with Reconstruction Within Standardized Regional Anesthesia Pathways

Authors: Perri S. Vingan, BS, Joanna Serafin, PhD, Lillian Boe, PhD, Kevin K. Zhang, BA, Minji Kim, BS, Leslie Sarraf, MD, Tracy Ann Moo, MD, Audree B. Tadros, MD, Robert Allen Jr., MD, Babak J. Mehrara, MD, Hanae Tokita, MD, Jonas A. Nelson, MD, MPH

Published in: Annals of Surgical Oncology | Issue 6/2024

Abstract

Background

Recent data suggest disparities in receipt of regional anesthesia prior to breast reconstruction. We aimed to understand factors associated with block receipt for mastectomy with immediate tissue expander (TE) reconstruction in a high-volume ambulatory surgery practice with standardized regional anesthesia pathways.

Patients and Methods

Patients who underwent mastectomy with immediate TE reconstruction from 2017 to 2022 were included. All patients were considered eligible for and were offered preoperative nerve blocks as part of routine anesthesia care. Interpreters were used for non-English speaking patients. Patients who declined a block were compared with those who opted for the procedure.

Results

Of 4213 patients who underwent mastectomy with immediate TE reconstruction, 91% accepted and 9% declined a nerve block. On univariate analyses, patients with the lowest rate of block refusal were white, non-Hispanic, English speakers, patients with commercial insurance, and patients undergoing bilateral reconstruction. The rate of block refusal went down from 12 in 2017 to 6% in 2022. Multivariable logistic regression demonstrated that older age (p = 0.011), Hispanic ethnicity (versus non-Hispanic; p = 0.049), Medicaid status (versus commercial insurance; p < 0.001), unilateral surgery (versus bilateral; p = 0.045), and reconstruction in earlier study years (versus 2022; 2017, p < 0.001; 2018, p < 0.001; 2019, p = 0.001; 2020, p = 0.006) were associated with block refusal.

Conclusions

An established preoperative regional anesthesia program with blocks offered to all patients undergoing mastectomy with TE reconstruction can result in decreased racial disparities. However, continued differences in age, ethnicity, and insurance status justify future efforts to enhance preoperative educational efforts that address patient hesitancies in these subpopulations.

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Title: Reducing Disparities: Regional Anesthesia Blocks for Mastectomy with Reconstruction Within Standardized Regional Anesthesia Pathways
Authors: Perri S. Vingan, BS
Joanna Serafin, PhD
Lillian Boe, PhD
Kevin K. Zhang, BA
Minji Kim, BS
Leslie Sarraf, MD
Tracy Ann Moo, MD
Audree B. Tadros, MD
Robert Allen Jr., MD
Babak J. Mehrara, MD
Hanae Tokita, MD
Jonas A. Nelson, MD, MPH
Publication date: 22-02-2024
Publisher: Springer International Publishing
Keywords: Nerve Block
Mastectomy
Published in: Annals of Surgical Oncology / Issue 6/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-15094-2

At a glance: The STEP trials

Springer Medicine

Reducing Disparities: Regional Anesthesia Blocks for Mastectomy with Reconstruction Within Standardized Regional Anesthesia Pathways

Abstract

Background

Patients and Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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