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Race and 30-Day Morbidity in Pediatric Urologic Surgery
David I Chu1, Douglas A Canning2, Gregory E Tasian2
1Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania chudi@email.chop.edu.
Insights
Black children undergoing urologic surgery face higher risks of 30-day complications, particularly with bladder and urinary diversion procedures. Further research is needed to reduce postoperative morbidity in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Quality Improvement
- Health Disparities
Background:
- Identifying high-risk patients is crucial for surgical quality improvement.
- Pediatric urologic surgery carries risks of postoperative complications.
Purpose of the Study:
- To assess the impact of race on 30-day surgical morbidity in pediatric urology.
- To evaluate the influence of specific procedure types on postoperative outcomes.
Main Methods:
- A cohort study using the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) registry.
- Analysis of 11,791 pediatric urologic cases from 2012-2013.
- Multivariate logistic regression to identify predictors of 30-day morbidity.
Main Results:
- Overall 30-day complication rate was 5.9%, higher for bladder and urinary diversion procedures.
- Non-Hispanic Black children had higher odds of overall complications and hospital-acquired infections compared to non-Hispanic White children.
- Bladder and urinary diversion procedures were associated with significantly higher surgical morbidity.
Conclusions:
- Black race and specific urologic procedures (bladder, urinary diversion) are linked to increased 30-day surgical morbidity.
- Further investigation into care processes is necessary to mitigate postoperative complications in pediatric patients.
Background And Objective:
Quality improvement in surgery involves identifying patients at high risk for postoperative complications. We sought to assess the impact of race and procedure type on 30-day surgical morbidity in pediatric urology.
Methods:
The National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) is a prospective registry of surgical cases from 50 and 56 pediatric hospitals in 2012 and 2013, respectively. We performed a cohort study of children followed in NSQIP-P who underwent urologic surgery. Forty unique operations were stratified into 6 clinically related procedure groups: ureteral, testicular, renal, urinary diversion, penile and urethral, or bladder procedures. Outcomes were 3 different composite measures of 30-day morbidity. Primary predictors were patient race and procedural group. Multivariate logistic regression was used to identify associations between race, procedure type, and postoperative morbidity.
Results:
Of 114 395 patients in the NSQIP-P cohort, 11 791 underwent pediatric urologic procedures. Overall 30-day complication rate was 5.9% and was higher in bladder and urinary diversion procedures. On multivariate analyses, non-Hispanic black compared with non-Hispanic white children had higher odds of 30-day overall complications (odds ratio 1.34; 95% confidence interval, 1.03-1.74) and 30-day hospital-acquired infection (odds ratio 1.54; 95% confidence interval, 1.08-2.20). Bladder and urinary diversion procedures relative to testicular procedures had significantly higher odds of surgical morbidity across all composite outcome measures.
Conclusions:
Black race and bladder and urinary diversion operations were significantly associated with 30-day surgical morbidity. Future efforts should identify processes of care that decrease postoperative morbidity among children.
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