Unequal Rates of Serious Perioperative Respiratory Adverse Events Between Black and White Children
Olubukola O Nafiu1, Kwaku Owusu-Bediako1, Wilson T Chimbira1
1Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Insights
Black children face higher risks of serious perioperative respiratory adverse events (PRAE) compared to white children. Preoperative respiratory comorbidity (PRC) also increases PRAE risk, highlighting the need for careful perioperative care in at-risk children.
Area of Science:
- Pediatric Anesthesiology
- Health Disparities
- Respiratory Medicine
Background:
- Unexplained higher rates of serious perioperative respiratory adverse events (PRAE) observed in Black children compared to white children undergoing otolaryngologic procedures.
- The contribution of preoperative respiratory comorbidity (PRC) burden to this racial disparity in PRAE for non-otolaryngologic procedures remains unclear.
Purpose of the Study:
- To evaluate if PRC burden contributes to racial disparities in serious PRAE among children undergoing non-otolaryngologic procedures.
- To compare the incidence of serious PRAE between Black and white children.
Main Methods:
- Retrospective cohort study of 18,538 Black and white children undergoing elective, non-otolaryngologic procedures (2007-2014).
- Serious PRAE (laryngospasm/bronchospasm) rates were compared across racial groups.
- Covariates included age, gender, recent upper respiratory infection, endotracheal intubation, PRC burden, and race-PRC interaction.
Main Results:
- Serious PRAE occurred in 9.6% of Black children versus 6.6% of white children.
- Being Black was independently associated with increased risk of serious PRAE (OR 1.70; 95% CI 1.11-2.62).
- Baseline PRC was independently linked to serious PRAE (p < 0.001), with no significant interaction between race and PRC.
Conclusions:
- Race and PRC are significant factors in serious PRAE risk, with Black children being at higher risk.
- Children with PRC, especially sleep-disordered breathing (SDB) and asthma, are at increased risk.
- Further research is needed to understand the mechanisms underlying these racial and comorbidity associations.
Background:
Recent data among pediatric otolaryngology patients showed unexplained higher rates of serious perioperative respiratory adverse events (PRAE) in black children compared to their white peers. We evaluated whether preoperative respiratory comorbidity (PRC) burden contributes to racial disparity in serious PRAE in children undergoing non-otolaryngologic procedures.
Methods:
Rates of serious PRAE (laryngospasm and/or bronchospasm) were compared across racial groups in a retrospective cohort of black and white children (N = 18538; black 10%) who underwent various elective, non-otolaryngologic procedures between 2007 and 2014 at a US tertiary Children's hospital. Self-reported race was the primary exposure while age, gender, recent upper respiratory tract infection, use of endotracheal intubation, PRC burden and an interaction term between PRC and race were covariates.
Results:
Serious PRAE occurred in 9.6% of black children and 6.6% of white children. Although there was no significant difference in age between the groups, being black (odds ratio (OR) 1.70; 95% confidence interval (CI) 1.11-2.62) was independently associated with serious PRAE. Similarly, baseline PRC was independently linked (p < 0.001) with serious PRAE. Notably, there was no significant (p = 0.454) interactions between race and PRC and serious PRAE in our subjects.
Conclusion:
Race and PRC are important considerations in the risk of serious PRAE and black children are especially at risk compared to their white peers. Children, with PRC (particularly those with SDB and asthma) are also at risk suggesting that due consideration should be given to these factors in the perioperative care of children undergoing elective surgical procedures. Mechanisms underlying these associations deserve further evaluation.
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