Race, Ethnicity, and Pediatric Postsurgical Mortality: Current Trends and Future Projections

Area of Science:

• Pediatric surgery outcomes
• Health equity research
• Public health policy

Background:

• Aggregate human costs of pediatric postsurgical mortality disparities remain unquantified in the US.
• Understanding racial inequalities in pediatric surgical outcomes is crucial for clinicians, policymakers, and the public.

Purpose of the Study:

• To contextualize the human costs of racial disparities in pediatric postsurgical mortality.
• To estimate excess deaths among Black and Hispanic children compared to white children.
• To evaluate policy interventions for reducing pediatric surgical mortality disparities.

Main Methods:

• Population-based study of 673,677 children undergoing intermediate to high-risk surgery (2000-2019).
• Estimation of excess deaths attributable to racial disparities.
• Modeling of mortality reduction targets and impact of a 2.5% annual reduction policy.

Main Results:

• Consistently higher risk-adjusted postoperative mortality for Black (aRR: 1.42) and Hispanic (aRR: 1.22) children versus white children.
• Disparities were more pronounced in nonteaching hospitals.
• 10,200 excess deaths occurred among minoritized children (average 536/year); a 2.5% annual reduction could prevent ~1100 Black children's deaths in a decade.

Conclusions:

• The study quantifies excess pediatric postsurgical deaths due to racial disparities.
• A framework is proposed to reduce pediatric postoperative mortality disparities within ten years.
• Focusing on solutions can guide actionable policy changes for improved child surgical outcomes.