Anesthesia & Analgesia最新文献_第2页

The Challenge of Unexplained Practice Variability 无法解释的实践差异带来的挑战

Anesthesia & Analgesia

Pub Date : 2024-12-16 DOI: 10.1213/ane.0000000000007059

Avery Tung

An abstract is unavailable.

引用次数: 0

Racial and Ethnic Disparities in Epidural Blood Patch Utilization Among Obstetric Patients in the United States: A Nationwide Analysis, 2016–2020 美国产科病人使用硬膜外血贴的种族和民族差异：2016-2020 年全国分析

Anesthesia & Analgesia

Pub Date : 2024-11-15 DOI: 10.1213/ane.0000000000006754

Paul P. Potnuru, Srikar Jonna, Barbara Orlando, Omonele O. Nwokolo

itating neuraxial anesthesia complication associated with significant maternal morbidity if undertreated. In this nationwide study, we examine the racial and ethnic disparities in the inpatient utilization of EBP after obstetric PDPH in the United States. METHODS: In this retrospective observational study, we used the National Inpatient Sample, a nationally representative database of discharge records for inpatient admissions in the United States, from 2016 to 2020. We analyzed delivery hospitalizations of women of childbearing age (15–49 years) diagnosed with PDPH. Adjusting for maternal and hospitalization characteristics as confounders, we used a multilevel mixed-effects logistic regression model to compare the rates of EBP utilization by race and ethnicity. Secondarily, among hospitalizations with an EBP, we examined the association between race and ethnicity and the timing of the EBP procedure. RESULTS: We analyzed 49,300 delivery hospitalizations with a diagnosis of PDPH. An EBP was performed in 24,075 (48.8%; 95% confidence interval [CI], 47.8%–49.9%) of these hospitalizations. EBP was performed in 52.7% (95% CI, 51.3%–54.1%) of White non-Hispanic patients with PDPH. Compared to White non-Hispanic patients, Black non-Hispanic (adjusted odds ratio [aOR] = 0.69; 99% CI, 0.56–0.84), Hispanic (aOR = 0.80, 99% CI, 0.68–0.95), and Asian or Pacific Islander patients (aOR = 0.74, 99% CI, 0.58–0.96) were less likely to receive an EBP. The median (interquartile range [IQR]) time to perform an EBP was 2 (1–3) days after admission, with 90% of EBP procedures completed within 4 days of admission. There was no significant association between race and ethnicity and the timing of EBP placement. CONCLUSIONS: In this nationwide analysis of delivery hospitalizations from 2016 to 2020 in the United States with a diagnosis of PDPH, we identified racial and ethnic disparities in the utilization of EBP. Minoritized patients identified as Black non-Hispanic, Hispanic, or Asian or Pacific Islander were less likely to receive an EBP for the treatment of PDPH compared to White non-Hispanic patients. Suboptimal treatment of PDPH may be associated with adverse long-term outcomes such as postpartum depression, posttraumatic stress disorder, and chronic headaches. Racial and ethnic disparities in EBP utilization should be further investigated to ensure equitable health care delivery....

产科 PDPH 是一种神经麻醉并发症，如果治疗不当，会导致产妇严重发病。在这项全国性研究中，我们探讨了美国产科 PDPH 后住院病人使用 EBP 的种族和民族差异。方法：在这项回顾性观察研究中，我们使用了全国住院病人抽样调查（National Inpatient Sample），这是一个从 2016 年到 2020 年美国住院病人出院记录的全国代表性数据库。我们分析了被诊断为 PDPH 的育龄妇女（15-49 岁）的分娩住院情况。在调整了作为混杂因素的产妇和住院特征后，我们使用多层次混合效应逻辑回归模型来比较不同种族和族裔的 EBP 使用率。其次，在使用 EBP 的住院患者中，我们研究了种族和民族与 EBP 程序时间之间的关联。结果：我们分析了 49,300 例诊断为 PDPH 的分娩住院病例。在这些住院病例中，有 24,075 例（48.8%；95% 置信区间 [CI]，47.8%-49.9%）实施了 EBP。52.7%（95% 置信区间，51.3%-54.1%）的非西班牙裔白人 PDPH 患者实施了 EBP。与白人非西班牙裔患者相比，黑人非西班牙裔患者（调整后的几率比 [aOR] = 0.69；99% CI，0.56-0.84）、西班牙裔患者（aOR = 0.80，99% CI，0.68-0.95）和亚裔或太平洋岛民患者（aOR = 0.74，99% CI，0.58-0.96）接受 EBP 的可能性较低。实施 EBP 的中位时间（四分位数间距 [IQR]）为入院后 2（1-3）天，90% 的 EBP 手术在入院后 4 天内完成。种族和民族与实施 EBP 的时间无明显关联。结论：在这项对美国 2016 年至 2020 年诊断为 PDPH 的分娩住院情况进行的全国性分析中，我们发现了 EBP 使用方面的种族和民族差异。与白人非西班牙裔患者相比，黑人非西班牙裔、西班牙裔、亚裔或太平洋岛民等少数族裔患者接受 EBP 治疗 PDPH 的可能性较低。PDPH 治疗效果不佳可能与产后抑郁、创伤后应激障碍和慢性头痛等长期不良后果有关。应进一步调查 EBP 使用中的种族和民族差异，以确保公平的医疗保健服务....。

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引用次数: 0

It Depends on Whom You Ask: Perceptions of Dignity-Related Distress Among Critically Ill Patients and Families 这取决于你问谁：重症患者及家属对尊严相关痛苦的看法

Anesthesia & Analgesia

Pub Date : 2024-11-15 DOI: 10.1213/ane.0000000000007077

Shahla Siddiqui

An abstract is unavailable.

没有摘要。

引用次数: 0

The World Federation of Societies of Anaesthesiologists’ Fellowship Programs: Past, Present, and Future 世界麻醉医师协会联合会的研究金计划：过去、现在和未来

Anesthesia & Analgesia

Pub Date : 2024-11-15 DOI: 10.1213/ane.0000000000006984

Pauline B. Wake, Patricia Livingston, Ekta Rai, Robert J. McDougall