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Disparities in Inadvertent Dural Punctures
Abstract Number: S4B-1
Abstract Type: Original Research
Introduction: Recent studies found that Spanish-speaking Hispanic and other non-English speaking parturients are less likely to use neuraxial anesthesia than English speaking women. (1,2) The authors postulated that language barriers to communication and understanding analgesic options may be present. We hypothesized that for similar reasons, complications of neuraxial anesthesia, specifically inadvertent dural puncture (ADP), would be increased in non-white women who reported a non-English preference (EP) for medical care.
Methods: We conducted a retrospective chart review of all consecutive deliveries from April 2016-December 2017 in our tertiary care institution, classifying parturients by primary language (EP vs. non-EP), and race (white vs. non-white). Cases of ADP from an epidural procedure were identified by ICD-9 and ICD-10 codes for spinal headache, blood patch, and from complication clusters, with confirmation of each case by chart review. This interim analysis was performed for one of two institutions that will be in our final data set. Results are presented as multivariable adjusted odds ratios with 95% confidence intervals, with p value < 0.05 considered statistically significant.
Results: Of the 6306 parturients, the majority (57%) were white with EP while 12.2% were non-white with non-EP. Overall ADP was present in 64/6306 (1%). Increasing likelihood of ADP was observed across each group, the highest absolute event rate observed in non-white/non-EP parturients (Figure 1).
In univariate analysis there was a small increased risk of ADP in non-white/non-EP parturients compared with white/EP, but this did not reach statistical significance. However, when controlling for age and BMI, there was a statistically significant aOR = 2.6 (95% CI 1.2 to 5.4) p=0.016.
Discussion: Successful neuraxial placement is facilitated by optimal positioning and effective communication, which may be limited by language barriers. This may increase difficulty while performing neuraxial procedures leading to increased risk of ADP. Though an infrequent complication, a substantial number of patients may still be affected. Given the increasing proportion of non-EP patients seeking obstetric anesthetic care, further replication in larger cohorts is warranted.
1. Toledo, A&A, 2016
2. Caballero, IJOA, 2014