Black children are over three times at risk of dying within 30 days of surgery than White kids, finds study
Black children are nearly 3.5 times more likely to die within 30 days after surgery compared to their white peers even if they are relatively healthy going into the operation, say researchers who conclude that race is a risk factor for postoperative death in apparently healthy children. In addition to their higher risk of death within a month, Black children have an 18% greater chance of developing complications, shows analysis.
Health experts have established for a long time that African-American patients have poorer surgical outcomes compared to white patients. The prevailing assumption was that the disparities in outcomes were largely due to higher "preoperative comorbidity burden" among African-American patients, writes lead study author Dr Olubukola Nafiu, pediatric anesthesiologist and vice-chair for Academic Affairs and Research at Nationwide Children's Hospital, in the study published in Pediatrics.
Challenging this assumption, the research team conducted a retrospective study, analyzing the National Surgical Quality Improvement Program–Pediatric database from 2012 through 2017. The authors identified children (17 years or less) who underwent inpatient operations and were assigned an American Society of Anesthesiologists (ASA) physical status of 1 (normal healthy patient) or 2 (patient with mild systemic disease).
The ASA physical status designation is a tool developed to help clinicians categorize a patient's physiological status in a way that could be helpful in predicting operative risk. They looked at whether disparities exist among different races in healthy children, who are expected to have a lower risk. "Generally, we expect that healthier patients should do well with surgeries. Healthy kids have low complication rates. The expectation should be that complication rates and/or mortality among healthy children won't vary based on racial category — what we found is that they do," says Dr Nafiu.
The study evaluated outcomes for 172,549 apparently healthy children (11.4% Black and 70.1% White) who had low-risk surgery across 186 medical centers in the US. Children were followed-up from admission to 30 days after surgery. Overall, about 14% of children developed postoperative complications during the study period.
Despite controlling for factors such as sex, age, year of the procedure, case urgency and operating time, researchers found that Black children had 3.43 times higher odds of dying within 30 days after surgery. "African-American children had a three-fold higher risk of postoperative death despite this being a relatively healthy cohort of children with a low preoperative comorbidity burden. This has serious implications for the perioperative care of African-American children because our analyses suggest that preoperative comorbidity burden may only partly explain the racial disparity in postsurgical outcomes in children," says the team.
They add, "We must, however, caution that the findings of the present analyses do not establish causality between race and postsurgical complications or mortality. Rather, in this study, we highlight the strong association between racial category and postoperative morbidity and mortality in apparently healthy African-American and White children."
Being African-American conferred 27% relative greater odds of developing postoperative complications, relative to being White. Black children also had 8% higher odds of developing severe adverse events after surgery. Such postoperative events could include cardiac arrest, sepsis, readmission or reoperation. "Among 172,549 apparently healthy children, the incidence of 30-day mortality, postoperative complications and serious adverse events were 0.02%, 13.9%, and 5.7%, respectively. Compared with being White, African-Americans had 18% relative greater odds of developing postoperative complications and 7% relative higher odds of developing serious adverse events," the findings state.
The research team next plans to look at what postoperative complications are driving the observed morbidity and death pattern in order to identify modifiable outcomes. "Future investigations into why complications occur and whether there are racial differences in survival after major postoperative complications may provide some insights into the pervasive racial differences in postsurgical complications and mortality in children," write authors.