The effect of race and gender on pediatric surgical outcomes within the United States

Abstract Purpose The purpose of this study was to examine risk-adjusted associations between race and gender on postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States. Methods 101,083 pediatric surgical patients were evaluated using the U...

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Bibliographic Details
Published in:Journal of pediatric surgery 2013-08, Vol.48 (8), p.1650-1656
Main Authors: Stone, Matthew L, LaPar, Damien J, Kane, Bartholomew J, Rasmussen, Sara K, McGahren, Eugene D, Rodgers, Bradley M
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Child
Child, Preschool
Continental Population Groups - statistics & numerical data
Ethnic Groups - statistics & numerical data
Female
Gender
Health Resources - utilization
Hospital Charges - statistics & numerical data
Hospital Mortality
Hospitals, Teaching
Hospitals, Urban - statistics & numerical data
Humans
Income - statistics & numerical data
Infant
Infant, Newborn
Insurance Coverage - statistics & numerical data
Intraoperative Complications - epidemiology
Length of Stay - economics
Length of Stay - statistics & numerical data
Male
Pediatric surgery outcomes
Pediatrics
Pediatrics - statistics & numerical data
Postoperative Complications - epidemiology
Race
Risk Factors
Sex Factors
Socioeconomic Factors
Specialties, Surgical - statistics & numerical data
Surgery
Surgical Procedures, Operative - economics
Surgical Procedures, Operative - statistics & numerical data
Treatment Outcome
United States - epidemiology
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Summary:Abstract Purpose The purpose of this study was to examine risk-adjusted associations between race and gender on postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States. Methods 101,083 pediatric surgical patients were evaluated using the U.S. national KID Inpatient Database (2003 and 2006): appendectomy (81.2%), pyloromyotomy (9.8%), intussusception (6.2%), decortication (1.9%), congenital diaphragmatic hernia repair (0.7%), and colonic resection for Hirschsprung's disease (0.2%). Patients were stratified according to gender (male: 63.1%, n = 63,783) and race: white (n = 58,711), Hispanic (n = 26,118), black (n = 9,103), Asian (n = 1,582), Native American (n = 474), and other (n = 5,096). Multivariable logistic regression modeling was utilized to evaluate risk-adjusted associations between race, gender, and outcomes. Results After risk adjustment, race was independently associated with in-hospital death ( p = 0.02), with an increased risk for black children. Gender was not associated with mortality ( p = 0.77). Postoperative morbidity was significantly associated with gender ( p < 0.001) and race ( p = 0.01). Gender ( p = 0.003) and race ( p < 0.001) were further associated with increased hospital length of stay. Importantly, these results were dependent on operation type. Conclusion Race and gender significantly affect postoperative outcomes following pediatric surgery. Black patients are at disproportionate risk for postoperative mortality, while black and Hispanic patients have increased morbidity and hospital resource utilization. While gender does not affect mortality, gender is a determinant of both postoperative morbidity and increased resource utilization.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2013.01.043