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


CONCLUSIONS
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.
Department of Surgery, The University of Virginia, Charlottesville, VA, USA.
Matthew L
ML
Stone
Damien J
DJ
Lapar
Bartholomew J
BJ
Kane
Sara K
SK
Rasmussen
Eugene D
ED
McGahren
Bradley M
BM
Rodgers
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
Gender; Pediatric surgery outcomes; Race