Mortality Among Black Children After Surgery Higher Than White Peers

It’s never easy to let your child go as they enter an operating room. Unless it is a dire emergency, you likely had time to think about the pros and cons of the surgery before agreeing to it and, with the help of the surgeon or medical team, understand the risks. Most non-cardiac surgery complication rates are low. But what if your child had a higher risk of complications after surgery, including sepsis, because of who they are, regardless of how healthy they were before surgery? What do you do then? This is a situation that faces parents of Black children.

According to a study published in the journal Pediatrics, Black children are three times more likely to die after non-cardiac surgery than their white peers. These particular findings come during the COVID-19 pandemic, in which studies in the U.S. and around the world are showing that Black people, regardless of previous state of health, social or economic status, or age, are also dying at higher rates than their white counterparts. This is concerning, but may not come as a surprise to people who study healthcare disparities between underserved communities. These are communities or populations defined as those who are lacking in primary care providers, and how have high infant mortality rates, high poverty, or a high elderly population.

What this Surgery Study Said

The researchers performed a retroactive study, which is a study that looks back at the records of patients over a set period. The study was a large one, including 174,549 otherwise healthy children. They underwent inpatient surgical procedures, most commonly an appendectomy. Although deaths following non-cardiac related surgery are rare among children, 36 in this group did die after the procedure. What was striking, however, is that although Black children were only 11% of the whole group, they made up half the deaths. And not only did they have a higher risk of dying, Black children experienced more complications after surgery. They had higher rates of blood transfusions, repeat surgeries, and sepsis.

More Numbers

The researchers looked further at the number of complications that occurred over a one-month period after surgery. Aside from the 36 deaths, almost 24,000 children experienced complications. Almost 10,000 had some sort of adverse event (an unforeseen or dangerous reaction). According to the researchers, compared with their white peers, Black children had:

• 43 times the odds of dying within 30 days after surgery
• 18% relative greater odds of developing postoperative complications
• 7% relative higher odds of developing serious adverse events

The study authors wrote: “Although mechanisms underlying racial disparity in postoperative complications and mortality remain largely speculative and hypothesis based, it is suggested in our study that complications do occur even in apparently healthy surgical patients and [Blacks] are at a distinct disadvantage.” They pointed out that in order to reduce the mortality, surgeons would need to focus on reducing post-operative complications that can occur in this group of patients.

What Can We Do?

Aside from more research to identify where changes must be made, preventative healthcare is key to avoiding many medical problems. It doesn’t eliminate all risk, but it does help prevent some illnesses and conditions. And preventative care can help identify issues before they progress too far. Partnerships between healthcare organizations and public organizations can also help providers identify issues that may not have otherwise been obvious.

Parents should also speak with their child’s surgeon to discuss their concerns, says Niranjan “Tex” Kissoon, MD, vice chair of the Global Alliance for Sepsis and co-chair of World Sepsis Day and the International Pediatric Sepsis Initiative. Dr. Kissoon is also a member of the Sepsis Alliance Advisory Board. “If there’s time for deliberation, in other words, the surgery is not an emergency, ask if you should be doing different things to prepare.” When the child is due to be discharged home, ask more questions. “Before leaving, ask what should they be looking out for and what should they be doing during that period of time to best aid in recovery? Ask what are the likely complications that could occur?” Dr. Kissoon also reminds parents to use the word sepsis if they are concerned. If your child shows any signs of infection or sepsis, say, “I’m concerned about sepsis.”

Learn more about how sepsis affects children in Sepsis and Children, part of the Sepsis Alliance Sepsis and… library.

 

Edited August 10, 2020, to include Dr. Kissoon’s comments.