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Race, Postoperative Complications, and Death in Apparently Healthy Children
Olubukola O Nafiu1, Christian Mpody2, Stephani S Kim2
1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio olubukola.nafiu@nationwidechildrens.org.
Insights
Even in healthy children, African American (AA) patients face significantly higher risks of surgical mortality and complications. These disparities persist regardless of preoperative health status, suggesting factors beyond comorbidities contribute to poorer outcomes.
Area of Science:
- Pediatric Surgery
- Health Disparities Research
- Surgical Outcomes Analysis
Background:
- Established racial disparities show African American (AA) patients have worse surgical outcomes than white patients.
- The common explanation is a higher burden of preoperative comorbidities in AA patients.
- This study investigates if these disparities exist in apparently healthy children, a low-risk group.
Purpose of the Study:
- To determine if racial differences in surgical outcomes exist among apparently healthy children.
- To compare postoperative outcomes between African American and white children with American Society of Anesthesiologists physical status 1 or 2.
Main Methods:
- Retrospective analysis of the National Surgical Quality Improvement Program-Pediatric database (2012-2017).
- Inclusion of children undergoing inpatient operations with ASA physical status 1 or 2.
- Univariable and risk-adjusted logistic regression used to compare outcomes between AA and white children.
Main Results:
- Among 172,549 healthy children, AA children had 3.43 times higher odds of 30-day mortality.
- AA children showed 18% greater odds of postoperative complications and 7% greater odds of serious adverse events compared to white children.
- Incidence rates: 30-day mortality (0.02%), postoperative complications (13.9%), serious adverse events (5.7%).
Conclusions:
- African American race is a significant independent risk factor for increased postoperative mortality and complications in apparently healthy children.
- Preoperative comorbidity burden alone does not fully explain the observed racial disparities in surgical outcomes.
- Further research is needed to identify underlying mechanisms driving these health disparities.
Background:
That African American (AA) patients have poorer surgical outcomes compared with their white peers is established. The prevailing presumption is that these disparities operate within the context of a higher preoperative comorbidity burden among AA patients. Whether these racial differences in outcomes exist among apparently healthy children (traditionally expected to have low risk of postsurgical complications) has not been previously investigated.
Methods:
We performed a retrospective study by analyzing the National Surgical Quality Improvement Program-Pediatric database from 2012 through 2017 and identifying children who underwent inpatient operations and were assigned American Society of Anesthesiologists physical status 1 or 2. We used univariable and risk-adjusted logistic regression to estimate the odds ratios and their 95% confidence intervals (CIs) of postsurgical outcomes comparing AA to white children.
Results:
Among 172 549 apparently healthy children, the incidence of 30-day mortality, postoperative complications, and serious adverse events were 0.02%, 13.9%, and 5.7%, respectively. Compared with their white peers, AA children had 3.43 times the odds of dying within 30 days after surgery (odds ratio: 3.43; 95% CI: 1.73-6.79). Compared with being white, AA had 18% relative greater odds of developing postoperative complications (odds ratio: 1.18; 95% CI: 1.13-1.23) and 7% relative higher odds of developing serious adverse events (odds ratio: 1.07; 95% CI: 1.01-1.14).
Conclusions:
Even among apparently healthy children, being AA is strongly associated with a higher risk of postoperative complications and mortality. Mechanisms underlying the established racial differences in postoperative outcomes may not be fully explained by the racial variation in preoperative comorbidity.
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