Racial and Ethnic Differences in Ostomy Creation in Pediatric Patients With Crohn's Disease

Crohn's disease (CD) has historically been more prevalent among non-Hispanic White populations; however, recent studies demonstrate rising incidence in non-White populations. Despite this shift, limited data exist regarding differences in emergent surgical intervention and ostomy creation in non-White versus White populations. This study evaluated whether non-White pediatric patients with CD experience higher rates of emergent surgical intervention and ostomy creation.

The National Surgical Quality Improvement Program Pediatric Database was queried from 2015 to 2021. Patients ≤18 y of age with a primary diagnosis of CD were identified using International Classification of Diseases-Tenth Revision (ICD-10) codes. Patients were stratified by race. The primary outcome was emergent or nonemergent ostomy creation identified using Current Procedural Terminology codes. Preoperative clinical factors and postoperative outcomes were evaluated.

Among 1356 patients with CD requiring surgery, 75.6% (n = 1025) were White, 15.5% (n = 210) Black, 6.6% (n = 90) Hispanic, 1.6% (n = 22) Asian, and 0.66% (n = 9) other. Asian (31.8%, n = 7) patients were more likely to require a nonelective ostomy compared to White patients (10.0%, n = 103). Non-White patients were more likely to require nutritional support (23.0% versus 17.8%, P = 0.0360) and have hematologic disorders (27.2% versus 20.7%, P = 0.0134). After adjustment, Asian patients had greater odds of emergent (odds ratio: 4.17, [1.10, 15.84], P = 0.0363) and nonemergent ostomy creation (odds ratio: 5.15, [1.86, 14.25], P = 0.0016).

In pediatric patients with CD, Asian race was associated with higher odds of emergent or nonemergent ostomy creation. Further investigation into racial differences in emergent management of CD is needed to understand these inequities.