title: Racial disparities in failure-to-rescue among children undergoing congenital heart surgery.
abstract: OBJECTIVE
  To determine if racial/ethnic disparities exist among children undergoing congenital heart surgery, using failure-to-rescue (FTR) as a measure of hospital-based quality.
  
  
  METHODS
  This is a retrospective, repeated cross-sectional analysis using admissions from the 2003, 2006, and 2009 Kids' Inpatient Database. All pediatric admissions (≤ 18 years) with a Risk Adjustment for Congenital Heart Surgery procedure were included. Logistic regression models examining complications, FTR, and overall mortality were constructed.
  
  
  RESULTS
  Hispanic ethnicity (OR 1.13, 95% CI 1.01-1.26) was associated with increased odds of experiencing a complication when compared with white race. However, black race (OR 1.66, 95% CI 1.33-2.07) and other race/ethnicity (OR 1.40, 95% CI 1.10-1.79) were risk factors for FTR. Although Hispanic ethnicity was associated with increased odds of experiencing a complication, it was not associated with FTR. In hospital fixed-effects models, black race and other race/ethnicity remained as "within hospital" risk factors for FTR.
  
  
  CONCLUSIONS
  Black children and children of other race/ethnicity had higher rates of mortality after experiencing a complication. This suggests that racial disparities may exist in hospital-based cardiac care or response to care.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA; Division of Critical Care Medicine and the Heart Center, Seattle Children's Hospital, Seattle, WA.
authors.forename: Titus
authors.initials: T
authors.lastname: Chan
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.
authors.forename: K Casey
authors.initials: KC
authors.lastname: Lion
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000208:ethnology / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000208:ethnology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology