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Patient-reported postoperative pain and stigmatizing language in anesthesia notes: a cross-sectional study

S E Harkins1, C D Thomas2, I I Hulchafo3

  • 1Columbia University Irving Medical Center, Department of Obstetrics & Gynecology, New York, NY, United States.

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|November 27, 2025
PubMed
Summary

Postoperative pain in obstetric patients was associated with increased documentation of stigmatizing language by anesthesiologists, particularly labeling patients as "difficult." This highlights potential bias in pain management and the need for bias-free perinatal care.

Keywords:
Clinician biasHealth equityNatural language processingPostpartum painStigmatizing language

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Health Services Research

Background:

  • Stigmatizing language in clinical notes can reflect provider bias.
  • Previous research indicated racial/ethnic disparities in documented stigmatizing language in obstetric notes.
  • The study aimed to explore the link between postoperative pain and anesthesiologist-documented stigmatizing language.

Purpose of the Study:

  • To investigate the association between postoperative pain and the use of stigmatizing language in anesthesia notes.
  • To identify specific types of stigmatizing language linked to patient pain status.

Main Methods:

  • Analysis of electronic health records from 4383 obstetric patients across two hospitals (2017-2019).
  • Pain defined as a verbal numerical pain score (VNPS) ≥ 1 post-cesarean delivery or operative procedure.
  • Natural language processing (NLP) algorithm used to detect stigmatizing language in free-text anesthesia notes.
  • Multivariable logistic regression applied to assess associations between pain and stigmatizing language.

Main Results:

  • Stigmatizing language appeared in 9.9% of postoperative anesthesia notes.
  • Patients reporting pain were significantly more likely to have any stigmatizing language documented (aOR, 1.64; 95% CI, 1.26-2.13).
  • Pain was associated with higher likelihood of language labeling patients as 'difficult' (aOR, 1.81; 95% CI, 1.34-2.45).
  • No significant differences found for language related to marginalized identities, authoritarian decisions, or credibility questioning.

Conclusions:

  • Postpartum patients experiencing pain demonstrated increased odds of having stigmatizing language documented.
  • Findings suggest anesthesiologists may perceive patients reporting pain as 'difficult.'
  • Quality improvement initiatives are needed to monitor pain management inequities and promote patient-centered, bias-free perinatal care.