Why Do Black Kids Fare Worse After Surgery?

Black children were also more likely to have bleeding severe enough to require a transfusion: nearly 10% had it, compared to about 7% of white children.

The biggest difference was seen in the risk of death – which, although very low, was more than three times higher among black children.

It is not known why, but higher rates of adverse events could be one, said Nafiu. If other studies can link particular complications to this increased risk of death, he added, hospitals and surgical staff may try to do something about it.

But why were black children at higher risk for complications in the first place? The study suggests that the underlying health issues are not to blame, but it cannot identify the real 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 whites, minorities in the United States often receive care in less performing hospitals.

Because of income and insurance coverage, said Raphael, black families may be limited in their hospital care options.

This is important because the results of surgery may be better, for example, in high volume hospitals. “If my hospital performs 100,000 appendicitis procedures per year,” said Raphael, “surgeons have a lot more experience, given the volume, than a hospital where 100 appendicitis procedures are performed per year.”

Since this study did not look at hospital factors, he said, it is not clear whether they could help explain racial disparities.

Bias could also be involved, said Raphael. For example, he noted, several studies have shown that doctors are more likely to “minimize pain in minority patients.”

Like Nafiu, Raphael pointed out that the absolute risks of death were very low in these children.

“It is also important to state that these are complex issues,” he said. “It would be helpful to have more information on the site of care, as the characteristics of the hospital are essential in determining why these differences occur.”

The results are based on records from a national pediatric surgery outcome tracking database. Nafiu’s team focused on 172,549 healthy children who underwent surgery between 2012 and 2017 – including orthopedic, abdominal and cerebral / vertebral procedures. Cardiac surgeries have been ruled out, Nafiu said.

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Jothi Venkat

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