Death after surgery is more than twice as likely for black children than white children. New models indicate which risk factors are most commonly associated with this outcome for both groups.
The issue: Surgery, while often lifesaving, is sometimes life-threatening. A national study that looked at 18 years of surgeries in children — over 2 million cases — found an inpatient mortality rate of slightly less than 1 percent. This rate, of course, varies among procedures. High-risk operations like surgery on the skull or organ transplants have higher rates of mortality. Beyond procedure type, though, other factors, such as race, are associated with differing mortality rates, too. A new study looks to break down this phenomenon further by identifying factors within racial groups that are associated with risk of death.
An academic study worth reading: “Race, Preoperative Risk Factors, and Death After Surgery,” Pediatrics, 2018.
About the study: Researchers at the University of Tennessee analyzed data from a national effort to collect information on surgical operations. They looked at which preoperative risk factors were present most commonly among African American and white children who died in the 30 days following a surgery. Based on these findings, the researchers created race-specific models to predict outcomes after surgery.
Key findings:
- The odds of dying after surgery for black children was 2.22 times that of white children.
- Risk factors more common among African American children and more strongly associated with death were ventilation, oxygen support, wound infection and neonatal status.
- Risk of death after surgery was higher for black children than white children even for risk factors that were more common or similarly prevalent in white children (e.g., sepsis).
- All patients who had two risk factors had an increased risk of death, but the effect was more pronounced among African American children.
- The researchers indicate that their new models could advance health equity by providing black families “accurate information on the surgical risks their children face, not risks based on analysis drawn from predominately white children.” Knowing which risk factors are most strongly associated with death for a particular race and intervening to reduce these risks could reduce disparities.
Other resources:
- The U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics offers datasets relating to children.
- The American College of Surgeons’ National Surgical Quality Improvement Program, this study’s data source, has its own risk calculator.
- Medscape, an online resource for physicians, has information on pediatric surgery.
Related research:
- We’ve covered pediatric disparities in asthma, diabetes, and antibiotic prescription.
- A study published in the American Journal of Surgery in 2014, “The Effect of Race on Outcomes for Appendicitis in Children: A Nationwide Analysis,” found that African American and Hispanic children were more likely to have complications than their white peers.
- A study published in the Journal of Neurosurgery: Pediatrics in 2015, “Racial and Socioeconomic Disparities in Outcomes Following Pediatric Cerebrospinal Fluid Shunt Procedures,” found that African American patients were more likely to die after surgery than their white peers.