Black children are 3.43 times more likely to die within 30 days after surgery when compared to their white peers, says a new study led by Columbus, Ohio's Nationwide Children’s Hospital published in Pediatrics.
A team helmed by Olubukola Nafiu, pediatric anesthesiologist and vice chair for Academic Affairs and Research at Nationwide, analyzed the outcomes of 172,549 healthy children’s surgeries and found that about 14% of children overall develop postoperative complications.
The study states that compared to white children, Black children showed 27% relative greater odds of developing problems after surgery. Black children are also 8% more likely to develop severe complications after surgery, the study said.
“That African American patients have poorer surgical outcomes compared to white patients has been established for a long time,” Nafiu said. “The prevailing assumption was that the disparities in outcomes were largely due to higher preoperative comorbidity burden among African American patients.”
Nafiu’s team analyzed the National Surgical Quality Improvement Pediatric Database data entries from 2012 through 2017 to retroactively identify children who underwent inpatient surgeries and were also given a physical status of one or two by the American Society of Anesthesiologists (ASA). This ASA designation is used to help clinicians predict the risk of an operation by assigning a number to the patient’s physiological condition.
A patient with an ASA rating of one (or ASA I) is considered a normal, healthy patient. One with an ASA rating of two (or ASA II) is a patient with mild systemic disease e.g. obesity or well-controlled diabetes.
“Generally, we expect that healthier patients should do well with surgeries. Healthy kids have low complication rates,” Nafiu said. “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.”
When adjusting for variables such as age, sex and year of operation, the study’s results did not change significantly.
“Importantly, we want to highlight that these findings are from observational data. Race doesn’t cause these outcomes, but it is strongly associated with them,” Nafiu said. “Our next job is to look at what postoperative complications are driving the observed morbidity and mortality pattern in order to identify modifiable outcomes.”