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Published on: May 26, 2023
Racial disparities in failure-to-rescue among children undergoing congenital heart surgery
Titus Chan1, K Casey Lion2, Rita Mangione-Smith2
1Department of Pediatrics, University of Washington, Seattle, WA; Division of Critical Care Medicine and the Heart Center, Seattle Children's Hospital, Seattle, WA.
Insights
Racial disparities in pediatric congenital heart surgery are evident. Black and other minority children face higher failure-to-rescue rates, indicating potential inequities in hospital cardiac care quality.
Area of Science:
- Pediatric Cardiac Surgery
- Health Disparities
- Hospital Quality Measurement
Background:
- Congenital heart surgery in children is complex and requires high-quality care.
- Failure-to-rescue (FTR) is a critical metric for assessing hospital-based quality and patient outcomes.
- Existing research suggests potential racial and ethnic disparities in pediatric healthcare.
Purpose of the Study:
- To investigate the existence of racial/ethnic disparities in pediatric congenital heart surgery.
- To utilize failure-to-rescue (FTR) as a key indicator of hospital quality.
- To analyze differences in complications, FTR, and mortality across racial/ethnic groups.
Main Methods:
- Retrospective, repeated cross-sectional analysis of the Kids' Inpatient Database (2003, 2006, 2009).
- Inclusion of pediatric patients (≤ 18 years) undergoing congenital heart surgery.
- Logistic regression models were employed to assess complications, FTR, and overall mortality.
Main Results:
- Hispanic ethnicity was linked to a higher likelihood of complications compared to white children.
- Black and other race/ethnicity were identified as risk factors for failure-to-rescue (FTR).
- Black and other race/ethnicity remained significant risk factors for FTR even within hospitals.
Conclusions:
- Black children and children of other race/ethnicity experienced higher mortality rates post-complication.
- These findings suggest potential racial disparities in the quality of hospital-based cardiac care or the response to care.
- Further research is warranted to address and mitigate these identified disparities in pediatric cardiac surgery outcomes.
Objective:
To determine if racial/ethnic disparities exist among children undergoing congenital heart surgery, using failure-to-rescue (FTR) as a measure of hospital-based quality.
Study Design:
This is a retrospective, repeated cross-sectional analysis using admissions from the 2003, 2006, and 2009 Kids' Inpatient Database. All pediatric admissions (≤ 18 years) with a Risk Adjustment for Congenital Heart Surgery procedure were included. Logistic regression models examining complications, FTR, and overall mortality were constructed.
Results:
Hispanic ethnicity (OR 1.13, 95% CI 1.01-1.26) was associated with increased odds of experiencing a complication when compared with white race. However, black race (OR 1.66, 95% CI 1.33-2.07) and other race/ethnicity (OR 1.40, 95% CI 1.10-1.79) were risk factors for FTR. Although Hispanic ethnicity was associated with increased odds of experiencing a complication, it was not associated with FTR. In hospital fixed-effects models, black race and other race/ethnicity remained as "within hospital" risk factors for FTR.
Conclusions:
Black children and children of other race/ethnicity had higher rates of mortality after experiencing a complication. This suggests that racial disparities may exist in hospital-based cardiac care or response to care.
