Introduction: In obstetrical health care, racial disparities have been documented in different aspects of maternal care and outcomes. We aimed to examine the effect of race as a factor in affecting outcomes of cesarean section done under epidural analgesia (CS under EA).
Methods: We performed a population-based retrospective analysis of the Nationwide Inpatient Sample (NIS) (years 2003-2013) in adult hospitalizations for women undergoing CS with EA to determine outcomes [cost, length of stay (LOS), discharge destination (DD)] and complications (hematoma, surgical site infection, postpartum haemorrhage, blood transfusion, severe anaesthesia complications, amniotic fluid embolism, disseminated intravascular coagulation (DIC), and pulmonary edema) using ICD-9-CM codes. Weighted univariate analysis by chi-square test was performed to analyze the associations between race and outcomes with complications. Multivariate linear regression was used to analyze the cost and LOS.
Results: Out of 87,076 women underwent CS with EA, 63% were Caucasians, 13% were African Americans (AA), 20% were Hispanics, 3% were Asians and 1% were Native Americans. The majority of health care coverage for Caucasians and Asians was private insurance, while AA, Hispanics and Native Americans were utilized Medicare and Medicaid. The AA had higher numbers of comorbid conditions including hypertension, obesity, diabetes and renal failure, except for congestive heart failure that was highest in Asians. Though AA had highest DD to home, but cost and LOS were slightly higher in comparison to other races. Though rates of adverse events were very small in the overall cohort, hematoma was highest in Hispanics, anaesthesia complications were highest among Native Americans, and DIC was highest in Asians. (Table)
Conclusion: Parturients undergoing CS under EA in minority groups especially AA had higher numbers of comorbidities. Risk stratifications among AA before CS procedure might improve outcome and reduce the cost burden and complications.