Related Experiment Video
Updated: Sep 10, 2025
A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Examining the racial and ethnic disparities in pediatric surgery using the surgical Desirability of Outcome Ranking
Ikemsinachi C Nzenwa1, Michael A Kochis1, Alyssa Stetson1
1Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Insights
Black children undergoing surgery have higher odds of undesirable outcomes, as measured by the Desirability of Outcome Ranking (DOOR) score. This highlights potential racial disparities in pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Health Disparities
- Socioeconomic Determinants of Health
Background:
- The Desirability of Outcome Ranking (DOOR) system aids in evaluating multiple postoperative outcomes.
- DOOR may improve the identification of risks linked to social determinants of health.
- This study investigates the connection between race, ethnicity, and DOOR scores in pediatric surgical patients.
Purpose of the Study:
- To examine the association between patient race and ethnicity and their Desirability of Outcome Ranking (DOOR) scores.
- To identify potential racial and ethnic disparities in postoperative outcomes among pediatric surgical patients.
Main Methods:
- Utilized data from the NSQIP-Pediatric database spanning 2012-2022.
- Included pediatric patients (≤18 years) who underwent general, urological, or gynecological surgery.
- Employed ordinal logistic regression to analyze the relationship between race, ethnicity, and DOOR scores (ranging 1-6).
Main Results:
- Analysis of 368,190 patients revealed significant associations between race, ethnicity, and DOOR scores.
- Black pediatric surgical patients exhibited increased odds of higher (less desirable) DOOR scores (OR 1.06).
- Hispanic pediatric surgical patients showed decreased odds of high DOOR scores (OR 0.89).
- These disparities persisted in general and non-elective surgical cases for Black patients.
Conclusions:
- Black children face a higher likelihood of experiencing less desirable surgical outcomes.
- Findings suggest racial disparities in pediatric surgical care quality.
- Further research is needed to develop targeted interventions for equitable care.
Introduction:
The Desirability of Outcome Ranking (DOOR) ranks multiple postoperative outcomes, potentially enhancing detection of risks influenced by social determinants of health. We examined the relationship between race, ethnicity, and DOOR scores in pediatric surgical patients.
Methods:
Using NSQIP-Pediatric 2012-2022, we identified patients (≤18 years) who underwent general, urological, and gynecological surgery. DOOR scores range from 1 (most desirable) to 6 (least desirable). Ordinal logistic regression assessed associations with race, ethnicity and DOOR scores.
Results:
Among 368,190 patients (64.3 % non-Hispanic White, 18.2 % Hispanic, 13.4 % non-Hispanic Black, 3.7 % non-Hispanic Asian, and 0.4 % non-Hispanic Native), Black patients had increased odds of higher DOOR scores (OR 1.06, 95 % CI 1.04-1.10), while Hispanic patients had decreased odds of high DOOR scores (OR 0.89, 95 % CI 0.86-0.92). In general and non-elective surgery, Black race was still significantly associated with higher DOOR scores.
Conclusions:
Black children faced greater odds of undesirable outcomes. Future work may inform equitable, targeted interventions.
Related Concept Videos
01:30Psychosurgery
Historical Development of Psychosurgery
In the 1930s, Portuguese neurologist Antonio Egas Moniz introduced a surgical procedure designed...
01:26Kidney Transplant II: Surgical Procedure
01:02Ranks
01:20Comparing the Survival Analysis of Two or More Groups