Brittany L Willer, Christian Mpody, Joseph D Tobias, Olubukola O Nafiu. Racial Disparities in Failure to Rescue Following Unplanned Reoperation in Pediatric Surgery. Anesth Analg 2021 Mar 1;132(3):679-685. PMID: 33332903
Editorial
Viviane G Nasr, James A DiNardo. Racial Disparities in Perioperative Outcomes in Children: Where Do We Go From Here? Anesth Analg 2021 Mar 1;132(3):676-678. PMID: 33591091
We recently passed the one-year anniversary of George Floyd’s murder. The very public execution has resulted in a racial injustice awakening that has profoundly shaken us out of our complacency. So, this article by Willer et al and the accompanying editorial is extraordinarily timely. I think most of us think, “hey, as physicians, as pediatric anesthesiologists, we are color blind and provide the highest level of professional care to ALL of our patients, regardless of their color, race, ethnicity, gender, yada yada yada”. Perhaps that’s why this paper is so important. Simply, we have a problem, a very real problem.
One of the important lessons of the Covid-19 pandemic was the exposure of tremendous health disparities amongst Black and Brown Americans and their white counterparts. That African American children have poorer postsurgical outcomes compared to white children is well known. These authors used “failure to rescue” (FTR), defined as death among patients who required a reoperation following an index inpatient surgical procedure, as a sensitive index of the quality of surgical care available at various institutions. Previous studies had shown that Black children are more likely than white children to require an unplanned postoperative reoperation. The author’s question: Was FTR more common in black children as well?
Unfortunately, the answer is yes, almost 2 times more likely than for whites and the timing was shorter, that is, it happened more quickly. There are many possible explanations: Black children in the study had higher incidences of chronic lung disease, asthma, higher ASA physical status, hematologic issues and cardiac issues. Other issues, that could not be measured include: prehosptial variables such as socioeconomic and insurance status. These nonclinical variables could affect the lead time to surgery which have been shown to affect the likelihood of postsurgical complications. Additionally, previous investigators have shown that minority patients tend to receive care in low-quality, minority-serving hospitals.
The authors conclude: “our findings may have important implications in targeting postoperative racial disparities. Due consideration should be given to including race in clinical risk stratification algorithms and ensuring that there is heightened awareness of the disparity by race in the risk of FTR among children requiring unplanned reoperation. Further studies aimed at better understanding the relationship between race and surgical outcomes should focus on the differential contributors to morbidity events in the early postoperative period.”
I know that I am shaken by this study. What are your thoughts? Myron Yaster MD