Black children who undergo urologic surgery are more likely than white children to have post-surgical complications and hospital-acquired infections 30 days after the surgery, according to a study examining a national database from more than 50 U.S.. pediatric hospitals.
Researchers analyzed data from nearly 12,000 patients who underwent pediatric urology procedures. The database — the National Surgical Quality Improvement Program-Pediatrics — is a registry of surgical cases, prospectively collected in 2012 and 2013. The current study covered 40 unique operations, classified into six clinically related procedure groups: Ureteral, testicular, renal, urinary diversion, penile and urethral, or bladder procedures. The surgeries spanned common and complex conditions.
The overall 30-day complication rate for all surgeries was 5.9 percent. In comparing non-Hispanic black children to non-Hispanic white children within 30 days after surgery, the study team found that black children had significantly higher odds of overall complications (odds ratio 1.34) and of hospital-acquired infection (odds ratio 1.54). These significant associations were independent of baseline health conditions, type of surgery and other factors, the researchers reported.
Within the six procedure groups, bladder procedures and urinary diversions had the highest rates of postoperative morbidity, occurring in over 20 percent of all pediatric patients. The researchers say these high complication rates are not surprising in these procedure groups, which include more complex reconstructive surgeries. Infections in particular are a common risk following these surgeries.
One possible explanation for the racial disparities, say the authors, is that black patients may be more likely than white patients to be treated at hospitals with fewer resources. These differences in resources may be reflected in differences in hospital-level processes of care to prevent post-surgical complications such as infections or readmissions.
Nonetheless, according to David I. Chu, MD, a fellow in pediatric urology at The Children’s Hospital of Philadelphia (CHOP), further research is needed, both to systematically investigate potential causes of these disparities, and to design care processes and other medical interventions to reduce those disparities.
The National Institutes of Health (NIH) recently recognized health disparities in surgery as a research priority. The NIH provided grant support for the study, “Race and 30-Day Morbidity in Pediatric Urologic Surgery,” which was published online in Pediatrics.