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Association Between Race, Gender, and Pediatric Postoperative Outcomes: An Updated Retrospective Review
Jordan E Jackson1, Ganesh Rajasekar2, Olivia Vukcevich1
1Department of Pediatric Surgery, University of California, Davis Medical Center, Sacramento, California.
Insights
Pediatric surgical outcomes show persistent racial and gender disparities. Black children and male children experienced more postoperative complications, indicating a need for new strategies to address these inequities.
Area of Science:
- Pediatric Surgery
- Health Disparities Research
- Health Outcomes
Background:
- Previous studies highlighted racial and gender disparities in pediatric surgical outcomes.
- A recent evaluation of these disparities has been lacking.
- Understanding trends in pediatric postoperative outcomes is crucial for improving care.
Purpose of the Study:
- To evaluate improvements in race- and gender-related pediatric postoperative outcomes.
- To assess changes in disparities since a 2003-2006 report.
- To identify risk-adjusted associations between race, gender, income, and complications.
Main Methods:
- Utilized the Kids' Inpatient Database (2009, 2012, 2016).
- Included 245,976 pediatric patients undergoing common surgical procedures.
- Employed multivariable logistic regression for risk-adjusted analyses.
Main Results:
- Postoperative complications were significantly associated with male gender and race.
- Black patients had higher odds of complications compared to White patients (aOR 1.3).
- Male patients had higher odds of complications compared to female patients (aOR 1.3).
Conclusions:
- No significant progress has been made in eliminating race- or gender-based disparities in pediatric surgical outcomes.
- Existing disparities persist, requiring urgent attention.
- New strategies are essential to address and mitigate these inequities.
Introduction:
There has not been a recent evaluation of the association between racial and gender and surgical outcomes in children. We aimed to evaluate improvements in race- and gender-related pediatric postoperative outcomes since a report utilizing the Kids' Inpatient Database data from 2003 to 2006.
Methods:
Using Kids' Inpatient Database (2009, 2012, 2016), we identified 245,976 pediatric patients who underwent appendectomy for acute appendicitis (93.6%), pyloromyotomy for pyloric stenosis (2.7%), empyema decortication (1.6%), congenital diaphragmatic hernia repair (0.7%), small bowel resection for intussusception (0.5%), or colonic resection for Hirschsprung disease (0.2%). The primary outcome was the development of postoperative complications. Multivariable logistic regression was used to evaluate risk-adjusted associations among race, gender, income, and postoperative complications.
Results:
Most patients were male (61.5%) and 45.7% were White. Postoperative complications were significantly associated with male gender (P < 0.0001) and race (P < 0.0001). After adjustment, Black patients were more likely to experience any complication than White patients (adjusted odds ratio 1.3, confidence interval 1.2-1.4), and males were more likely than females (adjusted odds ratio 1.3, confidence interval 1.2-1.4).
Conclusions:
No clear progress has been made in eliminating race- or gender-based disparities in pediatric postoperative outcomes. New strategies are needed to better understand and address these disparities.
