When healthy kids have surgery, serious complications are uncommon. But even in that low-risk scenario, Black children fare worse, a new study finds.
Looking at more than 172,000 U.S. children who had inpatient surgery, researchers found that Black kids faced higher post-operative risks. That included more than three times the risk of dying within 30 days.
Experts stressed that deaths were rare. Overall, 0.07% of African American children died, compared to 0.02% of white children.
But the disparity exists, they said. And since the kids were all apparently healthy, differences in underlying medical conditions do not explain it.
“We’re not trying to panic parents. Pediatric surgery is still safe,” said lead researcher Dr. Olubukola Nafiu, a pediatric anesthesiologist at Nationwide Children’s Hospital in Columbus, Ohio.
“What we’re trying to do is dig into why these disparities exist,” he said. “If we can identify something actionable, then we can further improve care.”
There is nothing new, of course, about racial disparities in health care outcomes, Nafiu pointed out. Many studies have found that Black Americans tend to fare worse than white patients — including when it comes to post-surgery complications.
That’s true of adults and, some studies have found, children as well.
But most pediatric studies have included kids with various health conditions going in to surgery. “And how sick you are before surgery is strongly related to how sick you are after surgery,” Nafiu said.
So it hasn’t been clear whether racial differences in those health conditions might explain disparities after surgery.
That’s why the new study — published online July 20 in Pediatrics — focused on children who were generally healthy going into surgery.
Since it’s expected that healthy kids will do well, Nafiu said his team thought they might not uncover any racial disparities. Yet they did.
Overall, about 6.2% of Black children had a “serious adverse event” within 30 days — including blood infections, a need for a repeat surgery or hospitalization, or cardiac arrest. The rate among white children was lower, at 5.7%, the investigators found.
Black children were also more likely to have bleeding severe enough to require a transfusion: Almost 10% did, versus about 7% of white children.
The biggest difference was seen in the risk of death — which, though very low, was more than three times higher among Black children.
It’s not clear why, but the higher rates of adverse events might be one reason, Nafiu said. If further studies can link particular complications to that heightened risk of death, he added, then hospitals and surgery staff can try to do something about it.
But why were Black children at greater risk of complications in the first place? The study suggests underlying health problems are not to blame, but it cannot pinpoint the true reasons.
One possibility is the site of care, said Dr. Jean Leclerc Raphael, director of the Center for Child Health Policy and Advocacy at Baylor College of Medicine in Houston.
Research shows that compared to white people, minorities in the United States often receive care at lower-performing hospitals.
Due to income and insurance coverage, Raphael explained, Black families may be limited in their options for hospital care.
That matters because surgery outcomes may be better, for example, at higher-volume hospitals. “If my hospital does 100,000 procedures for appendicitis a year,” Raphael said, “the surgeons have much more experience, given the volume, than a hospital where 100 procedures for appendicitis are done a year.”
Since this study did not look at hospital factors, he said, it’s not clear if they would help explain the racial disparities.
Bias could also be involved, Raphael said. As an example, he noted, several studies have found that doctors are more likely to “downplay pain from minority patients.”
Like Nafiu, Raphael emphasized that the absolute risks of death were very low among these children.
“It’s also important to state that these are complex questions,” he said. “Having more information on site of care would be helpful, as hospital characteristics are critical in determining why these differences occur.”
The findings are based on records from a national database tracking pediatric surgery outcomes. Nafiu’s team focused on 172,549 healthy children who had surgery between 2012 and 2017 — including orthopedic, abdominal and brain/spinal procedures. Heart surgeries were excluded, Nafiu said.
The American Society of Anesthesiologists has more about preparing for pediatric surgery.
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