Postoperative Complications and Death Risk Three Times Higher For Black Children: Study

Black children undergoing surgery face greater risks of death and postoperative complications than white children, according to the findings of a new study that highlights concerns about potential racial disparities in the quality of care provided in the United States.

African American children who underwent inpatient surgery had more than three times the risk of dying within 30 days of the surgery than white children, according to researchers with Nationwide Children’s Hospital in Ohio. The findings were online July 20 in the journal Pediatrics.

Researchers conducted a retrospective study analyzing data from 2012 to 2017 from the National Surgical Quality Improvement Program-Pediatric database.

The study identified children who underwent inpatient surgery and were assigned an American Society of Anesthesiologists physical status rating of 1 or 2. These were low-risk, non-cardiac inpatient surgeries.

A total of 172,000 healthy children up to age 17 who underwent inpatient surgery were included.

According to the findings, African American children had 3.42 times greater risk of dying within 30 days of having surgery than Caucasian children. Black children also had an 18% greater risk of developing postoperative complications, like infected wounds and other serious complications, like sepsis and cardiac arrest. Postoperative complication rates reached 14% and 6% for serious side effects.

Black children, compared to white children, also had a 7% increased risk of developing serious adverse events. In addition, death rates 30 days after surgery were 0.07% for African American children and only 0.02% for white children.

Even for lower risk procedures, African American children had worse outcomes compared to their white peers.

While underlying health risks may account for some of the disparity, it does not fully explain the racial variation, the researchers noted.

Researchers indicated the absolute number of deaths across the study period was “expectedly low” considering the study focused on healthy children with few underlying conditions. However, they did not expect the racial disparities.

Prior studies have indicated African Americans have poorer surgical outcomes compared with their white peers. Some of this can be explained by lack of quality healthcare in lower income areas; however this does not account for the entirety of the difference.

However, the study authors and a commentary  published alongside the study by Dr. Tiffani Johnson of the University of California in Sacramento, also highlighted implicit racial bias among doctors and other healthcare providers is a key aspect of poor medical care and worse outcomes for African American patients.

“Implicit racial bias is pervasive in society, and research has demonstrated that health care providers have similar levels of implicit racial bias as the general population,” wrote authors of the commentary. “Research on the impact of provider bias on medical decision-making has been focused largely on adult patient populations and has revealed mixed results. However, one study revealed that pediatric providers with greater implicit bias were more likely to prescribe narcotic medications for postsurgical pain for white children than Black children.”

Researchers indicate African American children may be receiving inequitable prenatal care, pediatric follow-up, and subspecialty referrals. Focusing on addressing pediatric health care disparities requires addressing implicit racial bias in healthcare and dismantling policies that lead to disproportionate health care among communities of color, they concluded.