Anesthesia Care for Patients Undergoing Total Joint Arthroplasty: A Narrative Review of Disparities in Regional Anesthesia and Recommendations for Future Research Directions

Abstract

Purpose of review: High-quality evidence substantiates the use of regional anesthesia for elective total joint arthroplasty. The use of regional anesthesia in this surgical population, therefore, can also be used to evaluate health care disparities and measure health equity. This narrative review assesses and summarizes available literature on disparities in the use of regional anesthesia for total joint arthroplasty and identifies factors contributing to those disparities.

Recent findings: We found that disparities exist in the use of regional anesthesia for total joint arthroplasty and are multifactorial in origin, encompassing patient characteristics such as race and ethnicity and systemic factors such as hospital type and insurance status. However, there is an overall paucity of literature focused specifically on drivers of disparities, and no evidence supporting interventions that may alleviate known disparities.

Summary: Disparities in use of regional anesthesia for total joint arthroplasty are multifactorial in origin and encompass differences in care at the levels of race, ethnicity, hospital, and insurance status, among others. Additional work is needed at the epidemiologic level to understand what factors underlie known disparities in anesthesia care and how best to promote health equity for surgical patients undergoing this set of procedures.

Keywords: Anesthesia; Arthroplasty; Conduction; Health equity; Healthcare disparities; Hip; Joint replacement; Knee; Nerve Block; Regional anesthesia; Shoulder.

Figure 1:

Elements Influencing Use of Regional Anesthesia for Total Joint Arthroplasty Multifactorial elements influence the decision to offer or perform regional anesthesia for a patient undergoing total joint arthroplasty. Any of these factors may underlie or be associated with population-level healthcare disparities for this surgical group. This figure is an extension of a schematic proposed by Wong et al. in their review of neuraxial versus general anesthesia for total knee and hip arthroplasty [24].