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Study: Odds of dying after surgery 3 times higher for healthy Black children than White :

July 20, 2020

Black children had more than three times greater odds of dying after surgery than White children despite being healthy, according to a new study.

Researchers from Nationwide Children’s Hospital’s Department of Anesthesiology and Pain Medicine set out to look at healthy children, since previous studies had attributed disparities to comorbidities among Black patients.

The team analyzed 2012-’17 data from the National Surgical Quality Improvement Program-Pediatric database, studying 172,549 children who had inpatient surgery. The children received an American Society of Anesthesiologists physical status of 1 or 2, indicating they were healthy or had only mild systemic disease.

About 13.9% of all children experienced post-operative complications, 5.7% had serious adverse events and 0.02% died, according to “Race, Postoperative Complications, and Death in Apparently Healthy Children,” (Nafiu OO, et al. Pediatrics. July 20, 2020,

Black children had nearly 3.5 times the odds of dying within 30 days after surgery compared to White children. Adjusted odds ratios showed Black children also had about 18% greater odds of post-operative complications and 7% greater odds of serious adverse events.

“Essentially, it suggests that the African American child, whether they’re healthy or whether they’re sick, deserves further preventive measures in order to reduce their risk of morbidity and mortality,” author Olubukola O. Nafiu, M.D., M.S., FRCA, said in video abstract.

Previous studies have suggested communication between the doctor and patient, clinician bias, resource allocation, household income and access to specialized care could play a role in disparities. Authors also noted their study did not take into account potential differences in hospital quality.

“In any case, racial disparity in healthcare outcomes is a multifactorial challenge that encompasses the interface of patient factors, family dynamics, social determinants, health care provider factors and hospital variables,” they wrote. “To be effective, efforts to reduce disparity in health outcomes (including post-surgical morbidity and mortality) will have to be multi-pronged.”

Tiffani J. Johnson, M.D., M.Sc., FAAP, a member of the AAP Section on Minority Health, Equity, and Inclusion who also served on the AAP Task Force on Addressing Bias and Discrimination, looked more closely at some of these factors in a related commentary.

Implicit bias, she noted, can impact a doctor’s communication, decision-making and relationship with a patient. Discriminatory systems also may prevent Black patients from accessing high-quality care.

“In addition to traditional quality improvement and research approaches to address disparities, achieving child health equity necessitates dismantling the policies and structures that perpetuate inequities,” she wrote. “Pediatric providers and organizations can begin by identifying and confronting our own biases, and serving as anti-racism advocates within our institutions as well as in our communities.”

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