Healthcare disparities in the perioperative setting: An analysis of the National Anaesthesia Clinical Outcomes Registry

Background There are numerous studies which indicate healthcare disparities exist in the United States. Aims This study aims to investigate healthcare disparities in perioperative setting. Methods The National Anaesthesia Clinical Outcomes Registry (NACOR) was analysed for the impact of socioeconomic status and gender on perioperative adverse outcomes in elective, non-obstetrical cases. Socioeconomic status was initially divided into six income groups using Thompson & Hickey class modifications and subsequently classified into three income group classification (lower, middle, and upper). Three adverse outcomes were studied: intraoperative cardiac arrest, unplanned ICU admissions, and mortality. Results A total of 1,800,506 non-emergency, non-obstetrical cases in NACOR documented the presence or absence of an adverse outcome. In these cases, 43.42 per cent were males and 56.58 per cent were females. The incidences of adverse outcomes per 10,000 were 8.64 for unplanned ICU admissions, 7.86 for intraoperative cardiac arrest not leading to death and 2.37 for intraoperative cardiac arrest leading to death. Patients in the upper socioeconomic group had significantly fewer adverse outcomes than patients in lower group for unplanned ICU admissions (OR 0.41, 95 per cent CI 0.28-0.59), cardiac arrest not leading to death (OR 0.21; 95 per cent CI 0.13–0.33), and cardiac arrest leading to death (OR 0.41 95 per cent CI 0.21–0.79). The lower class group was found to have more intraoperative cardiac arrests not leading to death than the middle class group. There was no statistical significance between the lower and middle income groups when analysing unplanned ICU admissions and mortality. Conclusion Our study has found that healthcare disparities do exist in the perioperative setting.