Racial differences in postoperative outcomes among otherwise healthy children

1. Through a retrospective analysis, researchers found that healthy African American children, when compared to healthy white children, had higher rates of 30-day postoperative mortality.

2. Healthy African American children, when compared to healthy white children, were more likely to suffer postoperative complications including significant adverse effects, bleeding requiring transfusion, sepsis, unplanned reoperation, unplanned tracheal reintubation, and surgical wound complications.

Evidence Rating Level: 2 (Good)

Study Rundown: African American children are known to have greater postoperative morbidity and mortality when compared to white children, but this difference was thought to be secondary to greater preoperative morbidity among African American children. Prior to this work, no study has examined the potential racial difference in postoperative morbidity and mortality among healthy children. To address this gap, researchers in the current study completed a retrospective analysis of data among healthy children undergoing surgical procedures. The study found that healthy African American children, when compared to healthy white children, had higher rates of 30-day postoperative mortality as well as higher rates of multiple postoperative complications. This study was strengthened by use of a robust surgical database that is nationally representative and includes 186 medical centers across the United States. However, the study does not take into account any between-site differences in care delivery regarding race, therefore not accounting for potential variation in quality received. This study highlights racial disparities associated with surgical care outcomes, which should be further investigated to aid in preventative efforts.

Click to read the study, published today in Pediatrics

Relevant Reading: Development and Evaluation of the American College of Surgeons NSQIP Pediatric Surgical Risk Calculator

In-Depth [retrospective cohort study]: Patient information was obtained from The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Children who were 17 years of age and younger who had inpatient surgeries from 2012 to 2017 were included for analysis. The NSQIP-P reports risk-adjusted surgical outcomes from 186 medical centers across the United States. Children were identified as healthy or with only mild systemic disease as denoted by American Society of Anesthesiologists (ASA) physical status 1 or 2 classification. A total of 172 549 children met inclusion criteria. 11.4% of the children were African American and 70.1% were white. 73.5% of the African American children were ASA class 2, whereas 68.2% of white children were ASA class 2. The distribution of age, gender, and preoperative comorbidities were overall similar between the two groups. The primary outcome studied was 30-day postoperative mortality and the secondary outcomes were overall 30-day postoperative complications and serious adverse events, which included cardiac arrest, sepsis, readmission, and reoperation. African American children, when compared to white children, had higher rates of postoperative 30-day mortality (0.07% vs. 0.02%; crude odds ratio [cOR] 3.48 with 95%CI 1.76-6.87), composite postoperative complications (16.87% vs. 13.80%; cOR 1.27 with 95%CI 1.22-1.32), and composite serious adverse events (6.17% vs. 5.71%; cOR 1.08 with 95%CI 1.02-1.15). Additionally, African American children had statistically significant higher rates of postoperative bleeding requiring transfusion (9.91% vs. 6.90%), sepsis (0.48% vs. 0.37%), unplanned reoperation (2.95% vs. 2.47%), unplanned tracheal reintubation (0.32% vs. 0.18%), organ surgical site infection (1.15% vs. 1.13%), superficial surgical site infection (0.99% vs. 0.94%), and surgical wound dehiscence (0.31% vs. 0.30%, p < .05 for all comparisons).

 Image: PD

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