Even among apparently healthy children, Black patients are almost three and a half times more likely to die within a month after surgery than white patients, according to a new study published in Pediatrics on Monday.
While previous research has explored racial disparities in surgical outcomes between adult patients, researchers in Monday’s study focused specifically on healthy children. In adults, those differences are often attributed to other overlapping health conditions or risks. But even when children had no underlying conditions, Black children still had a higher rate of death and complications after elective and emergency procedures than their white peers.
“A lot of people way, way smarter than us have documented this same disparity for years and years. My team and I are essentially the first to look at a relatively healthy cohort of children,” said Olubukola Nafiu, a study author and an anesthesiologist at Nationwide Children’s Hospital with a background in general pediatrics.
In the retrospective study, Nafiu’s team analyzed data from over 172,000 children who underwent surgery between 2012 and 2017, as recorded from hospitals across the country through the National Surgical Quality Improvement Program-Pediatric database. All of the patients were age 17 or younger, and all had been grouped as either healthy patients or patients with a mild disease. Both groups typically fare well post-surgery. Of the included patients, 70% were white and 11% were Black — all other racial and ethnic groups were excluded from the analysis.
In addition to a higher rate of death, Black children had 18% relative higher odds of developing complications after surgery, and 7% relative higher odds of developing serious adverse events, such as cardiac arrest, sepsis, readmission, or reoperation.
While Black children were more likely to experience negative outcomes than white children, the overall rates of death, serious adverse events, and complications were still extremely low. The mortality rate for Black children was 0.07%, compared to 0.02% for white children.
“Surgery is still safe. Complication rates were very low; mortality rates were very, very low,” said Nafiu, concerned that the findings might discourage Black patients or parents from seeking necessary treatment. “It confirms well-known doctrine that healthier patients do well.”
Stephanie White, a pediatrician and associate dean for diversity and inclusion at the University of Kentucky, who was not involved in the study, said that while she wasn’t surprised by the results, she was disappointed that the disparity was so stark.
“This is a great study, and it adds to a growing body of literature that calls for physicians to robustly evaluate the impacts that race has on health outcomes,” said White. “We can’t continue to tell these narratives without doing our own internal investigation.”
White suspects the way Black patients interact with the health care system may play a big role in overall outcomes. Research, as well as her own experiences as a Black patient, have shown her that doctors spend less time treating and speaking with Black patients than white patients.
The researchers pointed out that Black patients often receive care in hospitals that serve large populations of Black and brown patients and tend to be lower-quality, which appears to be a critical variable in the relationship between race and postoperative outcomes.
Nafiu and his team plan to next study the many potential factors that contribute to the disparity between Black and white pediatric patients. The team also saw that male patients had lower risks for negative outcomes than females did, and hope to investigate gender differences in future research as well.
“Unfortunately, from a retrospective study like ours, it’s going to be extremely difficult to tease out all those are factors,” said Nafiu.
Nafiu said he and his colleagues were well aware of the particular relevance of the study in the current moment, when there is renewed discussion of racism in medicine and racial health disparities.
Similarly, White hopes that the timing of the paper will help to spark discussions among pediatricians.
“I’m just really excited about the conversations that can come from this,” said White.