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Cited by 31Nausea and vomiting managementAnesthesia and Pain ManagementEnhanced Recovery After Surgery

Antiemetic Administration and Its Association with Race: A Retrospective Cohort Study

Open access
White, Robert S., Andreae, Michael H., Lui, Briana, Ma, Xiaoyue, Tangel, Virginia E., Turnbull, Zachary A., Jiang, Silis Y., Nachamie, Anna S. +2 more·2023·Anesthesiology
DOI 10.1097/aln.0000000000004549
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Abstract

Background: Anesthesiologists’ contribution to perioperative healthcare disparities remains unclear because patient and surgeon preferences can influence care choices. Postoperative nausea and vomiting is a patient- centered outcome measure and a main driver of unplanned admissions. Antiemetic administration is under the sole domain of anesthesiologists. In a U.S. sample, Medicaid insured versus commercially insured patients and those with lower versus higher median income had reduced antiemetic administration, but not all risk factors were controlled for. This study examined whether a patient’s race is associated with perioperative antiemetic administration and hypothesized that Black versus White race is associated with reduced receipt of antiemetics. Methods: An analysis was performed of 2004 to 2018 Multicenter Perioperative Outcomes Group data. The primary outcome of interest was administration of either ondansetron or dexamethasone; secondary outcomes were administration of each drug individually or both drugs together. The confounder-adjusted analysis included relevant patient demographics (Apfel postoperative nausea and vomiting risk factors: sex, smoking history, postoperative nausea and vomiting or motion sickness history, and postoperative opioid use; as well as age) and included institutions as random effects. Results: The Multicenter Perioperative Outcomes Group data contained 5.1 million anesthetic cases from 39 institutions located in the United States and The Netherlands. Multivariable regression demonstrates that Black patients were less likely to receive antiemetic administration with either ondansetron or dexamethasone than White patients (290,208 of 496,456 [58.5%] vs. 2.24 million of 3.49 million [64.1%]; adjusted odds ratio, 0.82; 95% CI, 0.81 to 0.82; P < 0.001). Black as compared to White patients were less likely to receive any dexamethasone (140,642 of 496,456 [28.3%] vs. 1.29 million of 3.49 million [37.0%]; adjusted odds ratio, 0.78; 95% CI, 0.77 to 0.78; P < 0.001), any ondansetron (262,086 of 496,456 [52.8%] vs. 1.96 million of 3.49 million [56.1%]; adjusted odds ratio, 0.84; 95% CI, 0.84 to 0.85; P < 0.001), and dexamethasone and ondansetron together (112,520 of 496,456 [22.7%] vs. 1.0 million of 3.49 million [28.9%]; adjusted odds ratio, 0.78; 95% CI, 0.77 to 0.79; P < 0.001). Conclusions: In a perioperative registry data set, Black versus White patient race was associated with less antiemetic administration, after controlling for all accepted postoperative nausea and vomiting risk factors. Editor’s Perspective: What We Already Know about This Topic: What This Article Tells Us That Is New:

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  • Data from 40 institutions revealed that Black patients received inferior care with respect to postoperative nausea and vomiting prophylaxis at nearly every single center.

    “Another failed case is found in the field of anesthesiology, where data from 40 institutions revealed that Black patients received inferior care (with respect to postoperative nausea and vomiting prophylaxis) at nearly every single center [86].”

    From Barriers to and facilitators of artificial intelligence adoption in health care: scoping review (2024) · cites this paper as [86]

    The Results (Perioperative Medicine; page unavailable) report lower antiemetic administration for Black patients in 32 of 39 hospitals (82.1%), supporting a disparity across most centers, not nearly every center in a 40-institution sample. The Racial Disparities in Antiemetic Administration section also says the study could not distinguish prophylactic use from postoperative rescue treatment, so it does not establish a disparity specifically in prophylaxis. (LLM, conf=0.94)

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1 of the 46 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Diemunsch P, Diemunsch AM: Economics of anti- emetics. Curr Opin Anaesthesiol 2002; 15:233-7

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Authors
White, R. S., Andreae, M. H., Lui, B., Ma, X., Tangel, V. E., Turnbull, Z. A., Jiang, S. Y., Nachamie, A. S., Pryor, K. O., & Multicenter Perioperative Outcomes Group Collaborators
Affiliations
  • American Society of Anesthesiologists (US)
  • University of Utah (US)
ORCID
Venue
Anesthesiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-05-09
Volume
138
Issue
6
Pages
587-601
ISSN
  • 0003-3022 (ISSN-L)
  • 1528-1175
DOI
10.1097/aln.0000000000004549
OpenAlex
W4375948509
Cited by
31
References
46
Citations by year
2026: 4 · 2025: 10 · 2024: 13 · 2023: 4
FWCI
8.32
Type
journal article
Language
en
Open access
Locations
  • Anesthesiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Weill Cornell Medical College
Topics
  • Health Sciences › Medicine › Surgery › Nausea and vomiting management
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Keywords
postoperative nausea and vomiting, racial disparities, Black patients, ondansetron, dexamethasone, anesthesiologists, health care disparities, patient-centered outcomes, postoperative opioid use, Medicaid, income inequality, patient preferences, surgeon preferences
MeSH terms
Antiemetics, Dexamethasone, Double-Blind Method, Humans, Retrospective Studies, Ondansetron, Postoperative Nausea and Vomiting

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