Exploring Racial and Ethnic Disparities in Outcomes Following Pediatric Cardiac Surgery: A NEPHRON Study Analysis

Racial and ethnic disparities in neonatal postoperative outcomes are reported, but differences in cardiac surgery-associated acute kidney injury (CS-AKI) remain unexamined. We assessed racial/ethnic disparities in CS-AKI prevalence and outcomes in neonates undergoing congenital heart surgery.

Retrospective cohort of neonates across 22 centers (2015-2018) from the Pediatric Cardiac Critical Care Consortium and the Neonatal and Pediatric Heart and Renal Outcomes Network.

Race/ethnicity (primary predictor) were categorized into eight groups; CS-AKI was defined using neonatal modified Kidney Disease: Improving Global Outcomes criteria as mild (stage 1), severe (≥ stage 2) and persistent (any stage beyond post-operative day [POD] 3). Outcomes included not achieving net negative fluid balance [FB], respiratory support duration, length of stay [LOS], and mortality. Multivariable regression models examining the association between race/ethnicity and outcomes were also constructed.

Among 2,165 neonates (2% Asian, 18% Hispanic, 1% multi-racial, 0.3% Native American, 14% Non-Hispanic Black (NHB), 59% Non-Hispanic White (NHW), 5% other, and 0.2% Pacific Islander), CS-AKI prevalence (31% mild, 23% severe) did not differ across racial/ethnic groups. NHB neonates had lower birthweight and higher surgical complexity, while NHW neonates had higher private insurance rates. NHB neonates were less likely to not achieve a net negative FB until ≥ POD3 than NHW neonates, but no differences were found in respiratory support duration, hospital LOS, or mortality after multivariate adjustment. Non-white neonates with severe AKI had higher mortality but had similar clinical outcomes.

CS-AKI rates did not vary by race/ethnicity. Differences in fluid balance achievement were noted but no significant disparities were found in mortality, mechanical ventilation duration, or hospital LOS.