Sociodemographic and Systems Risk Factors Associated With Nil by Mouth Noncompliance and Day-of-Procedure...

Area of Science:

• Pediatric Anesthesiology
• Health Services Research
• Health Equity

Background:

• Day-of-procedure cancelations significantly impact patients, families, and healthcare systems.
• Noncompliance with nil by mouth (nil per os [NPO]) guidelines is a primary cause of these cancelations.
• Previous studies on NPO noncompliance risk factors have yielded conflicting results.

Purpose of the Study:

• To identify demographic groups with higher rates of NPO noncompliance.
• To determine associations between demographic/system factors and procedure cancelations due to NPO noncompliance.

Main Methods:

• A multicenter retrospective case-control study of pediatric patients (<18 years) undergoing elective procedures.
• Data included sociodemographic factors and communication methods for NPO guidelines.
• Statistical analyses used chi-squared goodness-of-fit and multivariable logistic regression.

Main Results:

• NPO noncompliance occurred in 0.74% of 164,147 pediatric patients; 48% of these events led to cancelation.
• Risk factors for NPO noncompliance included younger age (<4 years), minority race-ethnicity, Spanish language of care, and public insurance.
• Cancelation odds increased with missed preprocedure calls, older age (>4 years), non-Hispanic African American/Black race, public insurance, and afternoon procedure scheduling.

Conclusions:

• Age, race-ethnicity, language of care, and insurance type are associated with NPO noncompliance.
• Specific demographic and system factors correlate with increased day-of-procedure cancelations.
• Findings indicate potential disparities in healthcare access, particularly for minority populations, necessitating targeted strategies to improve care access.