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Racial disparities in postoperative morbidity and mortality among high-risk pediatric surgical patients
Catherine Chen1, Christian Mpody1, Erica Sivak1
1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Black children with severe health conditions face higher postoperative risks, experiencing increased mortality and complications compared to White children. These disparities persist even after accounting for health status, highlighting systemic issues in pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Health Disparities
- Surgical Outcomes
Background:
- Postoperative complication and mortality rates have declined due to improved perioperative care in the US.
- However, not all racial groups have equally benefited from these advancements.
- Racial disparities in surgical outcomes among pediatric patients warrant further investigation.
Purpose of the Study:
- To test the hypothesis that there are no systematic differences in postoperative morbidity and mortality between Black and White children with severe health conditions (ASA physical status 4 or 5).
Main Methods:
- Retrospective cohort study utilizing data from the National Surgical Quality Improvement Program-Pediatric (2012-2019).
- Included Black and White children with ASA physical status 4 or 5 undergoing inpatient operations.
- Risk-adjusted odds ratios for 30-day postoperative mortality and complications were calculated using multivariable logistic regression.
Main Results:
- The study included 16,097 children (23% Black, 77% White).
- Black children had a 20% higher likelihood of 30-day mortality (9.3% vs. 7.2%) and increased odds of pulmonary (1.13 OR) and cardiovascular complications (1.28 OR).
- Black children also had a 33% higher likelihood of extended length of stay (LOS).
Conclusions:
- Black children with high ASA physical status experienced significantly higher rates of 30-day postoperative morbidity and mortality compared to White children.
- These findings suggest that racial disparities in surgical outcomes among the sickest pediatric patients are not solely explained by preoperative health status.
- Further research is needed to address the underlying causes of these disparities and improve equity in pediatric surgical care.
Study Objective:
With increasing improvement in perioperative care, post-surgical complication and mortality rates have continued to decline in the United States. Nonetheless, not all racial groups have benefitted equally from this transformative improvement in postoperative outcomes. We tested the hypothesis that among a cohort of "sick" (ASA physical status 4 or 5) Black and White children, there would be no systematic difference in the incidence of postoperative morbidity and mortality.
Design:
Retrospective cohort study.
Setting:
Institutions participating in the National Surgical Quality Improvement Program-Pediatric (2012-2019).
Patients:
Black and White children who underwent inpatient operations and were assigned ASA physical status 4 or 5.
Measurements:
risk adjusted odds ratios for 30-day postoperative mortality and complications using multivariable logistic regression models, controlling for various baseline covariates.
Main Results:
There were 16,097 children included in the analytic cohort (77.0% White and 23.0% Black). After adjusting for baseline covariates, Black children were estimated to be 20% more likely than their White counterparts to die within 30 days after surgery (9.3% vs. 7.2%, adjusted-OR: 1.20, 95% CI: 1.05-1.38, P = 0.007). Black children were also more likely to develop pulmonary complications compared to their White peers (52.1% vs. 44.6%, adjusted-OR: 1.13, 95%CI: 1.04, 1.23, P = 0.005). Being Black also conferred an estimated 28% relative greater odds of developing cardiovascular complications (4.6% vs. 3.3%, 95%CI: 1.06, 1.54, P = 0.010). Finally, being Black conferred an estimated 33% relative greater odds of requiring an extended LOS compared to Whites (50.7% vs. 38.7%, adjusted-OR: 1.33, 95% CI: 1.22-1.46, P < 0.001).
Conclusion:
In this cohort of children with high ASA physical status, Black children compared to their White peers experienced significantly higher rates of 30-day postoperative morbidity and mortality. These findings suggest that racial differences in postoperative outcomes among the sickest pediatric surgical patients may not be entirely explained by preoperative health status.
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