67 Disparities in Regional Anesthesia Block Acceptance for Mastectomy With Reconstruction Surgery in a Standardized Setting

Figure. Regional Block Volume and Block Refusal Over Time

Background

Available studies suggest disparities in receipt of regional anesthesia prior to breast reconstruction which presents a barrier to equitable perioperative care and pain management. Our goal was to study the factors associated with block receipt for mastectomy
with immediate tissue expander (TE) reconstruction in a high-volume ambulatory surgery practice with standardized regional anesthesia pathways.

Methods

This institutional review board–approved retrospective chart review included patients who underwent mastectomy with immediate TE reconstruction from 2017 to 2022. A total of 4213 patients who underwent mastectomy with immediate TE reconstruction were included. All eligible patients were offered preoperative nerve blocks as part of the clinical regional anesthesia pathway. Patients who declined a block were compared with those who opted for the procedure.

Results

Of all eligible patients who were offered preoperative nerve blocks, 91% accepted, and 9% declined the procedure. Univariate analyses revealed that patients with the lowest rate of block refusal were White, non-Hispanic, English speaking, with commercial insurance, and undergoing bilateral reconstruction. Over time, the rate of block refusal decreased from 12% in 2017 to 6% in 2022. Multivariable logistic regression identified the following variables which reduced the odds of receiving a block: older age (P = .011), Hispanic vs non-Hispanic ethnicity (P = .049), Medicaid vs commercial insurance (P < .001), unilateral vs bilateral surgery (P = .045), and reconstruction in earlier study years vs 2022 (2017, P < .001; 2018, P < .001; 2019, P = .001; 2020, P = .006).

Conclusions

In a standardized, preoperative regional anesthesia program with blocks offered to all clinically appropriate patients undergoing mastectomy, we found an overall low rate of block refusal and no difference in block acceptance based on race. Remaining differences in age, ethnicity, and insurance status suggest that further educational efforts are needed to address patient hesitancies in these populations.