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Racial Disparities in Failure to Rescue Following Unplanned Reoperation in Pediatric Surgery
Brittany L Willer1, Christian Mpody, Joseph D Tobias
1From the Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
Insights
African American children are twice as likely to experience failure to rescue (FTR) after unplanned reoperation compared to White children. This disparity is most pronounced in early reoperations, highlighting racial differences in surgical outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Quality Improvement
- Health Disparities
Background:
- Failure to rescue (FTR) and unplanned reoperations are critical surgical quality indicators.
- Racial disparities in postsurgical outcomes may stem from differences in FTR and reoperation rates.
Purpose of the Study:
- To investigate racial differences in the risk of FTR among children undergoing unplanned reoperation after inpatient surgery.
Main Methods:
- Utilized the National Surgical Quality Improvement Program database (2012-2017).
- Analyzed a cohort of pediatric patients (<18 years) requiring unplanned reoperation within 30 days of index surgery.
- Employed logistic regression to compare FTR rates between African American (AA) and White children, adjusting for covariates and stratifying by reoperation timing.
Main Results:
- Of 276,917 children, 10,425 (3.8%) had unplanned reoperations; 19.3% were AA. African American children had a 2-fold increased odds of FTR (aOR: 2.03).
- For early unplanned reoperations, AA children had 2.38 times higher odds of FTR (8.9% vs 3.4%).
- AA children experienced shorter time to mortality post-reoperation (5 days IQR) compared to White children (9 days IQR).
Conclusions:
- African American children face a significantly higher risk of FTR following unplanned reoperation compared to White children.
- The disparity in FTR is most pronounced in cases of early unplanned reoperation.
- Race is a critical factor influencing FTR in pediatric surgical patients, necessitating targeted interventions.
Background:
Failure to rescue (FTR) and unplanned reoperation following an index surgical procedure are key indicators of the quality of surgical care. Given that differences in unplanned reoperation and FTR rates among racial groups may contribute to persistent disparities in postsurgical outcomes, we sought to determine whether racial differences exist in the risk of FTR among children who required unplanned reoperation following inpatient surgical procedures.
Methods:
We used the National Surgical Quality Improvement database (2012-2017) to assemble a cohort of children (<18 years), who underwent inpatient surgery and subsequently returned to the operating room within 30 days of the index surgery. We used logistic regression models to estimate the odds ratio (OR) and 95% confidence interval (CI) of FTR, comparing African American (AA) to White children. We estimated the risk-adjusted odds ratio (aOR) for FTR by controlling the analyses for demographic characteristics, surgical profile, and preoperative comorbidities. We further evaluated the racial differences in FTR by stratifying the analyses by the timing of unplanned reoperation.
Results:
Of 276,917 children who underwent various inpatient surgical procedures, 10,425 (3.8%) required an unplanned reoperation, of whom 2016 (19.3%) were AA and 8409 (80.7%) were White. Being AA relative to being White was associated with a 2-fold increase in the odds of FTR (aOR: 2.03; 95% CI, 1.5-2.74; P < .001). Among children requiring early unplanned reoperation, AAs were 2.38 times more likely to die compared to their White peers (8.9% vs 3.4%; aOR: 2.38; 95% CI, 1.54-3.66; P < .001). In children with intermediate timing of return to the operating room, the risk of FTR was 80% greater for AA children compared to their White peers (2.2% vs 1.1%; aOR: 1.80; 95% CI, 1.07-3.02; P = .026). Typically, AA children die within 5 days (interquartile range [IQR]: 1-16) of reoperation while their White counterparts die within 9 days following reoperation (IQR: 2-26).
Conclusions:
Among children requiring unplanned reoperation, AA patients were more likely to die than their White peers. This racial difference in FTR rate was most noticeable among children requiring early unplanned reoperation. Time to mortality following unplanned reoperation was shorter for AA than for White children. Race appears to be an important determinant of FTR following unplanned reoperation in children and it should be considered when designing interventions to optimize unplanned reoperation outcomes.
