Time to strabismus surgery among racial and ethnic groups: a multicenter retrospective study

Racial variations in surgical care are known to exist. This study evaluates time to strabismus surgery among different racial groups by examining demographic and health factors.

We reviewed pediatric strabismus surgery patients' medical records at three academic institutions: Seattle Children's Hospital (2012-2022), Dean McGee Eye Institute (2012-2022), and Duke Eye Center (2013-2021). Patients with complete race classification and no previous strabismus surgeries were included. Demographic, insurance, and medical information were collected. Multivariable Cox regression analysis was performed to evaluate independent associations between race and time from diagnosis or surgical recommendation to surgery.

We included 1,216 pediatric patients, of whom 518 (42.6%) were non-White, 698 (57.4%) were White, and 587 (48.3%) were male. Mean patient age was 4.7 ± 3.8 years. Median time from diagnosis to surgery was longer for non-White compared to White patients (P = 0.002). Asian and Hispanic patients, and those of race specified as "Other," had longer time from diagnosis to surgery than White patients (median [95% CI] = 306 [230-430], 359 [299-582], 373.5 [225-537], resp. [P = 0.002]); there was a statistically significant association with race after adjusting for strabismus type and insurance type (P = 0.006), with hazard ratio (HR) 95% confidence interval of ≤1 for Asian, Hispanic, and Other race (HR = 0.75, 0.77, and 0.68, resp.). Multiracial patients and Native American / Native Alaskan patients had longer median times from recommendation to surgery than White patients (median [95% CI] = 79.5 [63-98], 81 [64-125], resp. [P = 0.0019]); there was a borderline significant association with race after adjusting for strabismus type and insurance type (P = 0.048), with HR 95% confidence interval of ≤1 for multiracial and Native American / Native Alaskan patients (HR = 0.72 and 0.82, resp.).

We found variation in time from diagnosis to strabismus surgery among pediatric patients. Non-White patients, specifically Asian, Hispanic, and Other, experienced longer time from diagnosis to surgery than White patients. Non-White racial groups, specifically multiracial and Native American / Native Alaskan, experienced longer time from recommendation to surgery compared with their White counterparts.