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Racial Disparities in Failure to Rescue after Pediatric Heart Surgeries in the US
Sundos Alabbadi1, Georgina Rowe2, George Gill2
1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Insights
Failure to rescue (FTR) after pediatric heart surgery decreased slightly from 2009 to 2019. Racial disparities in FTR persist, with Black children experiencing higher rates, potentially due to care location.
Area of Science:
- Pediatric Cardiac Surgery
- Health Disparities Research
- Patient Outcomes Analysis
Background:
- Failure to rescue (FTR) remains a critical metric in pediatric cardiac surgery.
- Understanding trends and risk factors for FTR is essential for improving patient outcomes.
- Racial disparities in healthcare outcomes are a significant concern in the United States.
Purpose of the Study:
- To analyze the national trends in failure to rescue (FTR) after pediatric heart surgery.
- To identify risk factors contributing to racial disparities in FTR.
- To investigate the impact of care location on racial differences in FTR outcomes.
Main Methods:
- Utilized the Kid's Inpatient Database to identify 85,267 pediatric congenital heart surgeries (2009-2019).
- Employed a mixed-effect logistic regression model with hospital random intercept to determine FTR predictors.
- Analyzed FTR rates across different racial groups, adjusting for demographics, medical complexity, and hospital factors.
Main Results:
- Overall FTR decreased from 7.4% in 2009 to 6.3% in 2019 (P=.02).
- Black children had higher FTR rates (8.5%) compared to White children (5.9%), with Black race being an independent predictor (OR, 1.40).
- If Black children received care at the same hospitals as White children, racial FTR disparities would decrease by 47.3%.
Conclusions:
- Significant racial disparities in failure to rescue (FTR) exist after pediatric heart surgery in the US.
- The location of care significantly contributes to these racial disparities, accounting for nearly half.
- Addressing disparities in access to high-volume surgical centers is crucial for mitigating racial differences in FTR.
Objective:
To identify the trend in failure to rescue (FTR) and risk factors contributing to racial disparities in FTR after pediatric heart surgery using contemporary nationwide data.
Study Design:
We identified 85 267 congenital heart surgeries in patients <18 years of age from 2009 to 2019 using the Kid's Inpatient Database. The primary outcome was FTR. A mixed-effect logistic regression model with hospital random intercept was used to identify independent predictors of FTR.
Results:
Among 36 753 surgeries with postoperative complications, the FTR was 7.3%. The FTR decreased from 7.4% in 2009 to 6.3% in 2019 (P = .02). FTR was higher among Black than White children for all years. The FTR was higher among girls (7.2%) vs boys (6.6%), children aged <1 (9.6%) vs 12-17 years (2.4%), and those of Black (8.5%) vs White race (5.9%) (all P < .05). Black race was associated with a higher FTR odds (OR, 1.40; 95% CI, 1.20-1.65) after adjusting for demographics, medical complexity, nonelective admission, and hospital surgical volume. Higher hospital volume was associated with a lower odds of FTR for all racial groups, but fewer Black (19.7%) vs White (31%) children underwent surgery at high surgical volume hospitals (P < .001). If Black children were operated on in the same hospitals as White children, the racial differences in FTR would decrease by 47.3%.
Conclusions:
Racial disparities exist in FTR after pediatric heart surgery in the US. The racial differences in the location of care may account for almost half the disparities in FTR.
