It's well known that Black people have higher rates of poor outcomes after surgery than their White counterparts. The prevailing cause of such disparity may be that, before surgery, Black adults have higher rates of chronic diseases — in addition to other potential factors such as implicit bias and structural racism.
Whether these same disparities exist among different races in healthy children, who are expected to have lower risk, hadn't been studied until now. Prior related research on children included analyses of those who had more serious diseases and disorders.
That complications and death still occurred at a higher rate for even healthy Black children in comparison to White peers who participated in the study highlighted that pre-surgery disease isn't the only factor leading to post-operation misfortune, the researchers said.
"Healthy kids have low complication rates," said Dr. Olubukola Nafiu, lead author of the study and pediatric anesthesiologist and vice chair for academic affairs and research at Nationwide Children's Hospital, in a press release.
"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," Nafiu said.
"Although these findings are unsurprising, they are still nonetheless terrifying and unacceptable," said Chicago pediatrician Dr. Nia Heard-Garris, who chairs the minority health, equity and inclusion committee of the American Academy of Pediatrics.
"To think of any children dying after surgery is distressing; however, children who have no or mild illness prior to surgery and to go on to experience complications, adverse events, or even death requires immediate attention and action," said Heard-Garris, who was not involved in the study.
Being Black "isn't the problem" that leads to disparities in health care, she added. "How our society treats, discriminates against, and denies equity to African Americans and other peoples of color encapsulates the problem and inexcusable deaths."
Greater risk for complications and death
In addition to their higher risk of death within 30 days, Black children had an 18% greater chance of developing complications. These kids also had a 7% higher likelihood of developing "serious adverse events," especially bleeding that required blood transfusions, and sepsis — the malfunctioning of organs, shock and death as a result of the body's response to harmful bacteria or viruses in the blood or tissues.
Black children, moreover, were at greater risk for undergoing surgeries and intubations for a second time that weren't part of the plan.
The children in the study were under 17 and part of the National Surgical Quality Improvement Program-Pediatric database from 2012 to 2017. The program is generally a reporting system designed to collect the outcomes of children undergoing surgical procedures at different medical sites in the United States.
Children included were those who underwent inpatie
