Race and socio – economic status influence acceptance of post operative epidural analgesia

Ochroch and associates (Anesth Analg 2007;105:1787) used a survey of patients scheduled for elective surgery to determine rates of acceptance of post operative epidural analgesia.  Over a four month period a trained research technician contacted the patients the day prior to their scheduled admission and then conducted a standard survey by telephone.  3739 patients were called at home, 1265 were contacted and 1193 consented to participate in the study.  64% of the study participants said that they would accept an epidural if recommended by an anesthesiologist and 36% said they would refuse.  The rate of acceptance increased to 78% if the epidural was recommended by both the surgeon and anesthesiologist with 22.5% still refusing.  A univariate logistic regression showed that patients with higher incomes, more education and who where employed full or part time were more likely to accept an epidural.  African Americans were far less likely then Caucasians to accept an epidural.  When controlling for gender, education level, employment type income and marital status, African American race predicted refusal of epidural analgesia. (OR 0.58, 95 % 0.32 – 0.78)  The authors attempted to determine some of the reasons for refusal but were unable to do so.  Of concern then is a group of patients who for some reason absent themselves from a proven form a post operative pain therapy that may have benefits with respect to reduced pain and improved recovery.  Of interest, from my observations, is the high acceptance of epidural analgesia on the HUP labor floor in a patient population that has a large number of African Americans (DSS comment).

Edward Andrew Ochroch M.D., MSCE is Associate Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania

David S. Smith, M.D., Ph.D.