A recent study, Race, Preoperative Risk Factors, and Death After Surgery, has found that black children are more than twice as likely to die following surgery than white children and describes race-specific models to predict surgical outcomes. The study has been published online, and will be published in the February 2018 issue of Pediatrics.
Authors Oguz Akbilgic PhD, assistant professor at the University of Tennessee Health Science Center (UTHSC), Max Langham, MD, a pediatric surgeon at Le Bonheur Children’s Hospital and professor of surgery and pediatrics and vice chairman of the Department of Surgery at UTHSC, and Robert Davis, MD, MPH, Governor’s chair and professor and founding director of UTHSC-ORNL Center for Biomedical Informatics examined 30-day postoperative mortality for more than 260,000 surgical procedures performed for children from 2012 to 2015. The data were compiled from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and include patients from children’s hospitals from across the nation. The authors developed race-specific models using preoperative risk factors to predict 30-day surgical mortality for black children versus white children.
They found a higher prevalence of risk factors for poor outcomes in black children that include ventilator use, oxygen support, wound infections, transfusions and neonatal status. The authors state that while they did not seek to assign or understand the cause of the increased risks of death following surgery, the use of race-specific models could more accurately identify patients at high risk for death following surgery as compared with models that examine all races grouped together. They suggest that interventions to decrease risks of death after surgery be tested within the context of race-specific risk strata to reduce the surgical mortality rate in black children.
Department Chair and pediatrician-in-chief Jonathan A. McCullers, MD sees this as an important milepost on the road to eliminating health disparities in surgical outcomes. “These data and the novel models derived from them will serve as critical tools to identify areas for intervention that we hope will eliminate some, if not all, of the disparities that arise from the poverty and limited access to comprehensive care for which black race is a marker not a cause.”
Is surgery riskier for black children?
Oguz Akbilgic et al, Race, Preoperative Risk Factors, and Death After Surgery, Pediatrics (2018). DOI: 10.1542/peds.2017-2221