Black children in US more than twice as likely to die from surgical complications, claims study
Do Black children face a higher risk during an operation? This may be true, according to researchers who found that Black children are more than twice as likely to die as compared to White children following surgical complications that require an unplanned additional operation. The study reveals that of 209 children who died during a second unplanned or emergency surgery: 135 were White (1.6% of all White children who suffered a complication) and 74 were Black (3.7% of all Black children who suffered a complication), implying that Black children were more than twice as likely to die.
The team from the Nationwide Children’s Hospital in Columbus, Ohio, wanted to assess a surgical outcome known as “failure to rescue” in Black children. In this context, it means that the patient suffered a post-surgical complication that led to a second unplanned operation but ultimately died. While previous studies have looked at racial disparities related to this outcome in children having heart surgery, the current study looked at the failure to rescue in all surgeries.
The authors analyzed data from the American College of Surgeons’ National Surgical Quality Improvement Pediatric Participant Use Data file. The results reveal that of 276,917 children who had an inpatient surgical procedure between 2012 and 2017, 10,425 (8,409 White children and 2,016 Black children) suffered a complication that sent them back to the operating room, and 209 subsequently died. According to the report, racial disparities in failure to rescue were greatest among the sickest children and when the reoperation occurred within four days of the initial surgery.
The research team notes many possible factors may lead to failure to rescue in Black children after surgery, which includes socioeconomic status, access to quality care, and preventive measures. Health risk factors that may cause failure to rescue may include a higher incidence of obesity, asthma, and sleep apnea, they add.
“We don’t fully understand all of the issues that place a Black child at greater risk and how all of these issues interact with each other. Our study gives physician anesthesiologists and surgeons insight into those at highest risk to heighten their awareness of the most vulnerable patients during the early postoperative period, which may have the biggest immediate impact on easing racial disparities,” said Dr Brittany Willer, lead author of the study and a pediatric anesthesiologist at Nationwide Children's Hospital, in a presentation at the Anesthesiology 2020, an annual meeting of the American Society of Anesthesiologists (ASA).
Minority children half as likely to have surgery as White kids
In a separate study, researchers from the University of Texas (UT) Southwestern Medical Center found that Black, Asian and Hispanic children are less likely to have surgery than White children. They examined data from the National Health Interview Survey, which is conducted by the Centers for Disease Control and Prevention (CDC). The study included 227,025 children, 18 years or younger, of whom 11,018 had received any type of inpatient or outpatient surgery within the previous 12 months.
After adjusting for factors, such as the health of the child, poverty, whether the child was insured and the level of education attained by the parents, the authors found that minority children were about half as likely as White children to have surgery. They add that there is no evidence to suggest that White children are more likely to need surgery or to have cosmetic procedures, factors that potentially could play a role in the large difference between the two groups. The findings were also presented at Anesthesiology 2020.
According to the investigators, the analysis could help lead to broader health disparities research, such as the routine collection of race and ethnicity data for children during all healthcare visits. They suggest that quality improvement initiatives such as standardized teaching for healthcare workers about systemic bias and cultural competency, as well as increasing workforce diversity, are also important.
“We must consider implicit systemic biases within perioperative healthcare. Bias can occur at several points, from deciding whether to refer a child to a surgeon, when a surgeon is deciding whether or not to operate on a child and when a physician anesthesiologist is deciding whether it is safe for a child to proceed with surgery. Further, some minority families may mistrust the health system, there may be communication or cultural difficulties, as well as barriers such as travel and the ability to take time off work,” explains lead author Ethan L Sanford, assistant professor of anesthesiology and pain management at UT Southwestern Medical Center.