Black children are more than twice as likely as their white peers to die following surgery, according to a study published in the February issue of Pediatrics.
The study noted that numerous health disparities between black and white Americans persist, such as higher mortality from cardiovascular disease, diabetes, cancer and trauma among black people. Further, black children are more likely to die following congenital heart surgery or neurologic procedures as well as experience complications from appendicitis, the study added.
The new research did not determine why there are poorer surgical health outcomes among black children. Instead, it used race-specific models to predict surgical mortality for black and white children. The use of such models leads to improved evaluation, according to lead study author Oguz Akbilgic, PhD, assistant professor at the University of Tennessee Health Science Center.
A non-race-specific mortality risk prediction model that he and researchers previously developed overestimated the risk of death for white children but underestimated it for black children. The current research sought to determine whether race-specific models could better identify patients at high risk for surgical mortality compared with models that group all races together, according to the study.
Researchers used the National Surgical Quality Improvement Program Pediatric Participant Use Data File, looking at the 30-day mortality post surgery for more than 267,000 surgeries in black and white children from 2012 to 2015. They developed race-specific predictive models using preoperative risk factors.
The study found that black children had significantly higher prevalence of risk factors for poor surgical outcomes, including ventilation, oxygen support, previous cardiac interventions, cerebrovascular injuries, wound infections, hematologic disorders and transfusions. Certain risk factors, including ventilation, oxygen support and wound infections, were also much more common among black children and had a significantly stronger association with death.
“Our study shows that the risk of postoperative death and (incidence) of critical preoperative risk factors are higher in black children compared to white, and race-specific risk strata help better (identify) high-risk patients,” Akbilgic told The Nation’s Health. “As is, our results can help medical teams in better evaluation of surgical mortality at a clinical level.”
Because of the risk factors, black children were 2.33 times more likely to die within 30 days of their surgeries, the study found.
It is also important to consider how other risk factors in surgical outcomes are connected to racial health disparities, Akbilgic said.
“Developing interventions to reduce mortality and racial health disparities requires complete understanding of causality patterns of racial health disparities in (surgical outcomes),” he said. “This is critical because the higher (incidence) rate of critical preoperative risk factors in black children are likely to be related to socio-economic risk factors or adverse childhood experiences...We are taking our research to the next level by taking socio-economic risk factors into account to fully understand the causality patterns of racial disparities in surgery outcome so that both at clinical and public health policy level interventions can be developed.”
For more information, visit http://pediatrics.aappublications.org/content/141/2/e20172221.
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