Racial and Ethnic Differences in Pediatric Perioperative Cardiac Arrest Survival

Perioperative cardiac arrest (POCA) is associated with substantial morbidity and mortality. Disparities in perioperative outcomes have been reported, but whether similar differences exist following pediatric POCA remains unclear. We evaluated racial and ethnic differences in 30-day mortality after pediatric POCA.

Within the American College of Surgeons National Surgical Quality Improvement Program for Pediatrics (NSQIP-P) registry, we identified 2646 children under 18 who underwent inpatient, noncardiac surgery (2012─2024) and experienced POCA. Race and ethnicity were categorized as Hispanic, non-Hispanic Asian, non-Hispanic Black or African American, non-Hispanic white, or other. Crude and adjusted risk ratios for 30-day mortality following POCA were estimated.

Among 2646 children with POCA, 47.9% (n = 1268) were non-Hispanic white, 28.2% (n = 745) non-Hispanic Black, 4.0% (n = 106) non-Hispanic Asian, 16.2% (n = 430) Hispanic and 3.7% (n = 97) Other race. Overall, 30-day mortality was 32.9% (871/2646). Mortality was similar across racial or ethnic groups (P = .72). In adjusted analyses, mortality risk did not differ significantly for non-Hispanic Black (adjusted relative risks [aRR] 1.02, P = .80), Hispanic children (aRR 1.06, P = .43), or children of other race (aRR 1.02, P = .88) compared with non-Hispanic white children. Emergent surgery (aRR 1.62, P < .001) and preoperative inotrope use (aRR 1.41, P < .001) were independently associated with increased mortality.

We found no significant racial or ethnic differences in mortality risk following POCA among children undergoing inpatient surgery. Mortality was associated with clinical and perioperative factors, including emergent surgery and preoperative inotrope use. This suggests that efforts to identify drivers of disparities in pediatric postsurgical mortality must look beyond POCA outcomes alone.