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Failure to rescue following postoperative pneumonia in pediatrics: Is there a racial disparity?
Jalen Warren1, Anna Gibbs2, Christian Mpody3
1Ohio University Heritage College of Osteopathic Medicine, Dublin Campus and Ohio University, Athens, Ohio, USA.
Insights
This study found no racial disparities in failure to rescue (mortality) following postoperative pneumonia in children. Further research is needed to address racial gaps in postoperative mortality.
Area of Science:
- Pediatric Surgery
- Healthcare Disparities
- Patient Safety
Background:
- Racial disparities in healthcare are well-documented, but less is known about disparities in failure to rescue after major adverse events.
- Failure to rescue, defined as mortality following a major adverse event, is a critical measure of hospital quality.
- Postoperative pneumonia is a serious complication that can lead to failure to rescue.
Purpose of the Study:
- To examine the association between race and failure to rescue following postoperative pneumonia in children.
- To determine if Black children experience higher rates of mortality after developing pneumonia post-surgery compared to White children.
Main Methods:
- Utilized the National Surgical Quality Improvement Program-Pediatrics Participant Use Data File (2012-2022).
- Included Black and White children under 18 who developed pneumonia after inpatient surgery.
- Used logistic regression to compare failure to rescue (mortality) rates between racial groups, adjusting for multiple covariates.
Main Results:
- The study included 3139 children (25.7% Black, 74.3% White) who developed postoperative pneumonia.
- Overall failure to rescue occurred in 3.7% of children (3.5% White, 4.3% Black).
- After adjustment, the odds of failure to rescue for Black children did not differ significantly from White children (aOR: 1.00; 95% CI: 0.62-1.61).
Conclusions:
- No significant racial disparities were found in failure to rescue following postoperative pneumonia in children.
- Future research should investigate race and failure to rescue in other postoperative complications to reduce racial gaps in mortality.
Introduction:
Racial disparities in measures of health and healthcare processes are well described. Limited work exists on disparities in failure to rescue - hospital mortality following a major adverse event. Postoperative pneumonia is a serious, potentially preventable adverse event that often leads to death, i.e., failure to rescue. This study examined the association of racial grouping with failure to rescue following postoperative pneumonia.
Methods:
We utilized the National Surgical Quality Improvement Program-Pediatrics Participant Use Data File to assemble a cohort of children <18 years who underwent inpatient surgery from 2012 to 2022. We included Black and White patients who developed pneumonia following an index surgery. The primary outcome was failure to rescue, defined as mortality following postoperative pneumonia. We used logistic regression models to estimate the odds ratio and 95% confidence intervals of failure to rescue, comparing Black and White children.
Results:
The study cohort included 3139 children <18 years who developed pneumonia following inpatient surgery. Of those, 2333 (74.3%) were White and 806 (25.7%) were Black. Failure to rescue occurred in 117 of the children (3.7%); 82 were White (3.5%) and 35 were Black (4.3%). After adjusting for gender, age, American Society of Anesthesiologists Physical Status classification, emergent/urgent vs. elective case status, year of operation, and pre-existing comorbidities, the odds of failure to rescue for Black children with postoperative pneumonia did not differ from White children (adjusted-Odds Ratio: 1.00; 95% Confidence Interval 0.62-1.61; p-value = .992).
Conclusion:
We found no significant difference in the odds of failure to rescue following postoperative pneumonia between Black or White children. To improve postoperative care for all children and to narrow the racial gap in postoperative mortality, future studies should continue to investigate the association of race with failure to rescue following other postoperative complications.
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