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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Racial Health Disparity Associated With Poor Pediatric Cardiac Surgery Outcomes: A Multicentered, Cross-Sectional
Shaun P Setty1,2, Lauren C Reynolds3, Vanessa C Chou3
1Division of Pediatric Cardiac Surgery, MemorialCare Heart and Vascular Institute, Long Beach, California, USA.
Insights
Racial disparities impact pediatric cardiac surgery outcomes, with non-White children experiencing higher mortality and longer hospital stays. Further research is needed to address these health disparities in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Health Disparities Research
- Congenital Heart Disease Outcomes
Background:
- Health disparities are recognized as a significant factor influencing outcomes in pediatric cardiac surgery.
- Existing research indicates a link between socioeconomic and racial factors and patient prognosis.
Purpose of the Study:
- To assess risk factors associated with adverse clinical outcomes in pediatric cardiac surgery.
- To investigate the impact of race on mortality and length of stay after pediatric cardiac surgery.
Main Methods:
- Utilized the Pediatric Health Information System Database (October 2015-December 2020).
- Categorized 59,856 pediatric patients by cardiac surgery complexity using Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2).
- Performed multivariable regression analyses to identify significant risk factors for mortality and postoperative length of stay.
Main Results:
- Non-White race was independently associated with a 1.2-fold increased mortality risk (P=0.008) and longer postoperative length of stay by 1.04 days (P<0.001).
- These disparities were more pronounced in non-White neonates, showing a 1.3-fold increased mortality risk (P=0.003) and a 2.05-week longer postoperative length of stay (P<0.001).
- Factors like mechanical ventilation, ECMO, infection, and surgical complications significantly increased mortality.
Conclusions:
- Racial differences significantly affect outcomes in pediatric cardiac surgery, particularly in neonates.
- Findings highlight the need for further evaluation and mitigation strategies to address racial disparities in pediatric cardiac surgery care.
Background:
Health disparities are known to play a role in pediatric cardiac surgery outcomes.
Objectives:
Risk factors associated with poor clinical outcomes were assessed.
Methods:
Using Pediatric Health Information System Database, pediatric subjects undergoing cardiac surgery using International Classification of Diseases 10th Revision from October 2015 to December 2020 were evaluated. Subjects were categorized by case complexity using the newly validated Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2). Multivariable regression analyses were conducted to ascertain risk factors.
Results:
A total of 59,856 subjects, median age 7.4 months (IQR: 1.5-61 months) were included; 38,917 (low), 9,833 (medium), and 11,106 (high) RACHS-2. Overall, hospital mortality was 3% and postoperative length of stay (LOS) was 7 days (IQR: 4-18 days), with significant increases in both mortality and postoperative LOS from low to high RACHS-2 scores by multivariable analysis, Kaplan-Meier, and Cox regression. Mechanical ventilation, extracorporeal membrane oxygenation, infection, and surgical complication were most significantly associated with increased mortality by 1.198 to 10.227 times (P < 0.008). After controlling for these significant variables as well as RACHS-2, age at surgery and emergency/urgent admission type, multivariable analysis revealed that non-White race was associated with increased mortality (relative risk: 1.2, 95% CI: 0.729-0.955, P = 0.008) and increased postoperative LOS by 1.04 days (95% CI: 0.95-0.97, P < 0.001). This significant increase in both clinical outcomes was concordant in non-White neonates (mortality relative risk: 1.3, 95% CI: 1.1-1.6, P = 0.003; and postoperative LOS by 2.05 weeks (95% CI: 1.36-3.10, P < 0.001).
Conclusions:
The influence of racial differences in neonates and children should be further evaluated to mitigate any disparity in those undergoing cardiac surgery.
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