Title: Racial and Ethnic Disparities in Preoperative Anxiolytic Medication Delivery

Authors: Derek Pan (1), Gundappa Neelakanta (2), Tristan Grogan (3)

Advisor: Gundappa Neelakanta (2)

Statistician: Tristan Grogan (3)

Affiliations: 

1 UCLA David Geffen School of Medicine, Los Angeles, CA

2 Department of Anesthesia, UCLA Health, Los Angeles, CA

3 Department of Medicine Statistics Core, UCLA Health, Los Angeles, CA

Area of Concentrations: Masters of Public Health at Fielding, Research

Specialty (if any): Anesthesiology

Keywords: Anesthesiology, Preoperative Anxiety, Disparities

Background

Much research has been done to elucidate the racial disparities in Anesthesia such as pain medication management, postoperative antiemetic administration, and obstetric epidural delivery. However, one area that lacks comprehensive disparities investigation is in preoperative anxiolytic delivery.

Current literature demonstrating possible disparities in preoperative anxiolytic administration consists of one-to-one racial or ethnic comparisons in Pediatric Anesthesia settings, which may not be generalizable to adult patients, nor does it show a comprehensive analysis of racial disparities. To date, there has been no comprehensive study that compares rates of preoperative anxiolytic delivery across multiple races/ethnicities in the adult patient population. 

Objective

This study aims to determine if adult racial minority patients are less likely to receive preoperative anxiolytics than their Caucasian counterparts.

Methods

Adult patients aged 18-89 who underwent surgery at UCLA hospitals from 2013-2023 were included in a retrospective UCLA Epic CareConnect chart review. Race categories were: Caucasian, Black, and Hispanic/Latino. The following procedures were excluded: ophthalmology, gastroenterology, pulmonary, ICU, and OBGYN. IRB committee found that this study did not require approval due to deidentification of data.

Using the UCLA data, the rates of anxiolytic delivery (whether or not they received preoperative midazolam) for each race/ethnic group was determined, alongside age, gender, insurance status (Medi-Cal, Medicare, other insurance), ASA score, booking type (emergent, elective, inpatient, transplant, urgent), total time for procedure, and prior anxiety diagnosis (ICD codes F41.0, F41.1, F41.3, F41.8, F41.9).

Statistical analysis used a univariable logistic regression (midazolam yes/no, unadjusted) and multivariable logistic regression model (adjusted for characteristics above).

Results

The total study population was 186619 patients, with 123113 Caucasian,16624 Black, and 46882 Hispanic patients. 

The raw rates of anxiolytic medication delivery without accounting for characteristics such as average age, gender, insurance status, and prior anxiety diagnosis were: 66% for Caucasians, 64.2% for Blacks, and 67.6% for Hispanic/Latino patients.

After controlling for above characteristics, Black patients had reduced odds (approximately 8%) of receiving preoperative midazolam compared to Caucasians (OR 0.92, 95% CI 0.88-0.95) p<0.001) and Hispanic patients had reduced odds (approximately 15%) of receiving preoperative midazolam compared to Caucasians (OR 0.85, 95% CI 0.83-0.88) p<0.001).

Conclusion

This single-center study identified racial disparities in the delivery of preoperative anxiolytics, with Black and Hispanic patients having statistically lower odds of receiving preoperative midazolam than Caucasian patients. It is unclear what the causes of this disparity are, or whether this disparity exists across the U.S. healthcare system. Future analysis should investigate the underlying causal sources of this disparity, and whether these findings can be generalized nationwide.