Black children with no apparent health issues are more likely to face complications and death after surgeries than their white counterparts, a new study published by Pediatrics found. Details indicate that in the 30 days after surgery, healthy Black children are more than 3.5 times more likely to die.
Health discrepancies between Black and white patients is well-documented, and the COVID-19 pandemic has revealed death rates for Black and Hispanic/Latinx patients are significantly higher. When it comes to surgical procedures, a previous study found that Black patients face higher mortality rates. However, the data linked these mortality rates to Black patients with higher rates of chronic illness.
“Generally, we expect that healthier patients should do well with surgeries. Healthy kids have low complication rates,” said Dr. Olubukola Nafiu in a news release. “The expectation should be that complication rates and/or mortality among healthy children won’t vary based on racial category. What we found is that they do.”
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The study was a statistical analysis of 172,549 healthy individuals under age 17 who underwent operations documented in the National Surgical Quality Improvement Program-Pediatric database between 2012 and 2017. Each child was assigned an American Society of Anesthesiologists physical status 1 or 2 — indicating that they were either healthy or had a mild, well-controlled condition that did not limit them physically.
Out of the total sample, risks of postoperative complications and other serious effects were low, yet Black children disproportionately faced them. The researchers found that in addition to being more than three times more likely to die, Black children had 18% greater odds of developing post-surgical complications and faced a 7% higher chance of developing “serious adverse events” such as bleeding and sepsis. Additionally, they were at higher risk of undergoing surgeries and intubations following their prior operation that were not part of the original plan.
Many environmental factors can affect post-surgery health including the effects of structural racism. The study suggests that Black children may be more likely to die after surgeries because they are more likely to suffer harmful events. The database the researchers studied did not give specifics on hospitals, so the report did not include any information on the quality of hospitals of the cultural competence of their care. However, a similar study on adults has shown that hospitals that treat large numbers of Black patients have higher death rates for all patients.
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Poverty and lack of access to healthcare and health insurance lead to hospitals being segregated. The Pediatrics study notes the necessity of understanding whether hospital segregation — and therefore lower quality of care in majority-Black hospitals — is a contributor to Black children’s death rates.
“Importantly, we want to highlight that these findings are from observational data,” Nafiu said in the news release. “Race doesn’t cause these outcomes, but it is strongly associated with them. Our next job is to look at what postoperative complications are driving the observed morbidity and mortality pattern in order to identify modifiable outcomes.”