Health care disparities based on race, ethnicity, gender preference and other demographic characteristics are unfortunately common. What about when healthy children undergo surgery? Does race make a difference in outcomes and rates of complications? We would hope not, but sadly according to a new study by Nafiu et al (10.1542/peds.2019-4113), it does. The authors of this study we are releasing this month in our journal share with us the results of their retrospective study from the National Surgical Quality Improvement Pediatric Database 2012 to 2017 involving 172,549 otherwise healthy children based on the pre-op anesthesia evaluation undergoing surgery and looked at mortality and post-op morbidity. The percentages of post-op complications and serious adverse events was 13.9% and 5.7% with a 30-mortality of 0.02%. African American (AA) children had 3.4 greater odds of dying within 30 days of surgery compared to children who were white and also greater odds of post-op complications (1.18 95% CI 1.13-1.23) including 7% higher odds of serious adverse events (1.07 95% CI 1.01-1.14).
So why is this? The authors control for a number of variables and find that racial variation in pre-op co morbidity is not the full explanation. The discussion section elucidates other factors that may be contributing to the disparities that may require efforts that extend beyond the operating room including resource allocation and access to the appropriate level of surgical expertise for a given operation, social determinants of health that affect a family’s ability to access health care in a timely, safe, and effective way. The authors also raise factors affecting the individual patient, their family, their environment, as well as implicit biases that may exist in health care professionals and staff, as well as the overall quality of the surgical services offered to children in a particular hospital. Examining the problem of racial differences in surgical outcomes could be a great quality improvement project for your local surgical service if similar disparities exist as in this study by Nafiu et al.
