Risk factors for mortality after surgery, including use of ventilation, oxygen support and wound infections, are more prevalent in black children than in white children and pose a significantly greater risk of death, according to research published in Pediatrics.
According to Oguz Akbilgic, PhD, from the UTHSC-ORNL Center for Biomedical Informatics and the department of preventive medicine at the Health Science Center in the University of Tennessee, and colleagues, the use of race-specific models to assess the risk of death may mediate this difference.
“Racial and ethnic health disparities are pervasive in the United States. Life expectancy for African Americans in the U.S. lags behind that for white individuals, and African Americans experience greater mortality from cardiovascular disease, diabetes, cancer and trauma,” Akbilgic and colleagues wrote.
“Racial and ethnic health outcomes disparities also exist among children,” the researchers continued. “African American children are more likely to die after congenital heart surgery or neurologic procedures and are more likely to have complications to appendicitis. African American children experience delays in getting placed on kidney transplant lists, wait longer periods on transplant lists and are less likely to receive kidney transplants compared with white children.”
To determine the risk factors for death after surgery, whether these differed based on race, and whether race-specific stratification models were more likely to detect this risk, Akbilgic and colleagues collected clinical data from The National Surgical Quality Improvement Program Pediatric Participant Use Data File concerning operations conducted on children within the U.S. The risk factors associated with mortality within 30 days after surgery were assessed to determine their prevalence and whether they increased chance of death in black and white children.
Of the 183,123 surgeries included in the dataset, 621 resulted in death within 30 days after surgery. The risk of death was calculated at 0.0034 (95% CI, 0.0031-0.0037). Black children were more likely to die within this time (risk = 0.0060; 95% CI, 0.0051-0.0071) than white children (risk = 0.0027; 95% CI, 0.0024-0.0030), making the OR for mortality after surgery for black children 2.22 compared with white children (95% CI, 1.83-2.70).
The researchers observed that risk factors for death and their prevalence varied based on race, with black children more frequently receiving ventilation and oxygen support and experiencing previous cardiac interventions, cerebrovascular injuries, wound infections, hematologic disorders, inotropic support, transfusions and poor neonatal status. White children were more at risk of experiencing sepsis, malignancy and emergent cases than black children.
Furthermore, the researchers observed that ventilation, oxygen support, wound infection and neonatal status were linked to a significantly higher likelihood of death. When risk factors were more prevalent in white children or prevalence was comparable, the risk of death remained higher in black children.
When used to predict the risk of death after surgery, race-specific risk models demonstrated a specificity of 94% and a sensitivity of 83% for black children. When a race-specific model was used to assess the risk of death for white children, the model demonstrated a specificity of 96% and a sensitivity of 77%. Both models, according to Akbilgic and colleagues, were significantly different.
“The separate classification trees built for African American and white children reveal better estimates of risk for each terminal-node risk group,” Akbilgic and colleagues wrote. “Although 4% improvement in sensitivity may seem a modest improvement from a statistical point of view, even a modest reduction in false-negatives for predicting mortality may have clinical importance. The finding that ventilation indicates that African American children are in the highest risk group is novel and demands further investigation.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.