Even in Apparently Healthy Children, Post-operative Risks Are Higher for Black Children Than White, Study Finds

Black children were nearly 3.5 times more likely to die within 30 days of surgery than white children in a retrospective study that analyzed postoperative deaths and complications. The study, “Race, Postoperative Complications, and Death in Apparently Healthy Children,” is published in the August 2020 Pediatrics (published online July 20). Authors reviewed records of 172,549 apparently healthy children who underwent inpatient operations from the National Surgical Quality Improvement Program–Pediatric database from 2012 through 2017. Even among apparently healthy children, being Black relative to being white was associated with a three-fold increased risk of post-operative death and complications. Overall, 13.9% of children developed postoperative complications within 30 days of surgery. Being Black conferred 27% relative greater odds of developing postoperative complications, relative to being white. Black children also had 8% higher odds of developing severe adverse effects post-surgery, compared with white children. These results did not change substantially after adjusting for covariates that include sex, age, year of procedure, case urgency and

operating time. Race is a key determinant of postoperative outcomes, and in general, Black patients compared to their white peers have higher rates of postoperative deaths and complications. Poverty, lack of access to health care and biological predisposition are among factors that have been used to explain the frequently observed racial disparity in health care outcomes. The study does not establish race as a cause for postsurgical complications or death but as an association. The authors conclude these results may help guide preoperative discussions about risks and may guide future studies to explain the mechanisms underlying racial differences in post-surgical outcomes in children.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.