Patient-reported postoperative pain and stigmatizing language in anesthesia notes: a cross-sectional study (2017–2019)

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BACKGROUND: Stigmatizing language reflects provider bias. Researchers found that documentation of stigmatizing language in obstetric clinical notes differed by patient race and ethnicity. The purpose of this study was to examine associations between postoperative pain and stigmatizing language documented by anesthesiologists. METHODS: We studied the electronic health records of obstetric patients at two hospitals between 2017 and 2019 (n = 4383). Pain was defined as a verbal numerical pain score (VNPS) ≥ 1 following cesarean delivery or other operative procedure during the delivery hospitalization. Stigmatizing language was identified in the free-text narratives of postoperative anesthesia notes using a well-performing natural language processing algorithm. Multivariable logistic regression was employed to examine associations between pain and stigmatizing language. RESULTS: Stigmatizing language was found in 9.9% of postoperative notes. Patients with documented pain were significantly more likely to have any stigmatizing language documented by anesthesiologists compared with patients with no pain (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.26-2.13). Patients with pain were also significantly more likely to have language labeling them as 'difficult' (aOR, 1.81; 95% CI, 1.34-2.45). There were no significant differences between patients with and without postoperative pain in language related to marginalized language/identities, unilateral/authoritarian decisions, or questioning patient credibility categories. CONCLUSIONS: In this cross-sectional study, postpartum patients with pain had increased odds of stigmatizing language. Findings suggest anesthesiologists may perceive patients who report pain as being 'difficult.' Quality improvement studies should track inequities in pain management as patient-centered, bias-free care is crucial for improving perinatal equity.

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