Racial Disparities in Failure to Rescue Following Unplanned Reoperation in Pediatric Surgery

Edition: March-April 2021

Willer BL, Mpody C, Tobias JD, Nafiu OO. Anesth Analg. 2021;132(3):679-685. doi:10.1213/ANE.0000000000005329

This paper reviewed a retrospective cohort of African American (n=2016) and White (n=8409) children who underwent unplanned re-operation following a primary surgical procedure over the period of 2012-2017. The primary outcome of failure to rescue was defined as all-cause mortality within 30 days of a primary surgical procedure.

In this cohort, African American children were more likely to be ASA > 3 (18.5% vs 12.7%), have a tracheostomy (4.1% vs 2.7%), have a history of chronic lung disease (18.6% vs 9.1%), haematologic disorder (14.9% vs 9.4%) and a cardiac risk factor (29.7% vs 23.5%). Compared to the White cohort, African American children had a higher incidence of failure to rescue (3.7% vs 1.6%). If an early re-operation was required (within 4 days of a primary surgical procedure), the mortality rates for African American children was significantly higher than for White children (adjusted odds ratio of 2.38; 95%CI 1.54-3.66; P <0.001). Regardless of when the unplanned re-operation occurred, African American children were more likely to die sooner after the re-operation than White children.

Take home message

This paper builds on emerging data demonstrating racial disparity in perioperative outcomes in children1. The reason for this disparity will be multifactorial, with socioeconomic and cultural factors playing a part in access to primary, pre-hospital and hospital care, increasing perioperative risk2. We mustn’t forget that as anaesthetists, we also play an important role in recognising unconscious bias and address inequity when we see it.

References

  1. Chan T, Lion KC, Mangione-Smith R. Racial disparities in failure-to-rescue among children undergoing congenital heart surgery. J Pediatr. 2015;166(4):812-8.e84. doi:10.1016/j.jpeds.2014.11.020
  2. Nasr VG, DiNardo JA. Racial Disparities in Perioperative Outcomes in Children: Where Do We Go From Here?. Anesth Analg. 2021;132(3):676-678. doi:10.1213/ANE.0000000000005383

Reviewed by Dr Scott Ma

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