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October 03, 2020
10/3/2020 10:00:00 AM - 10/3/2020 11:00:00 AM
Room Virtual
Racial Disparities In Failure To Rescue Following Return To The Operating Room In Pediatric Surgery
Brittany Willer, M.D., Christian Mpody, MBA, MPH, Joseph Tobias, M.D., Olubukola O. Nafiu, M.D.,F.R.C.A
Nationwide Children's Hospital, COLUMBUS, Ohio, United States
Disclosures: B. Willer: None. C. Mpody: None. J. Tobias: None. O.O. Nafiu: None.
Introduction: Although it has been shown that African American (AA) children have a greater risk of failure to rescue (FTR) following surgical complications, whether this racial disparity functions among children who return to the operating room (unplanned reoperation) has yet to be characterized. Generally, patients with the most serious surgical complications (requiring reoperation) represent a group that could be targeted for preventive or quality improvement measures. Whether there are racial differences in the proportion of children who die during their index admission following unplanned reoperation is presently unknown. Here, we sought to determine whether racial differences exist in the FTR rates among children who are returned to the operating room following surgery.Methods: We used the National Surgical Quality Improvement database (2012-2017) to assemble a cohort of children (<18 years of age), who underwent inpatient surgery and subsequently returned to the operating room. To adjust for confounding resulting from racial differences in baseline comorbidities we performed a stratified propensity analysis by dividing the cohort into 4 mutually exclusive risk-groups with increasing propensity score of return to the operating room (low-risk, intermediate-low-risk, intermediate-high-risk, and high-risk). The propensity score was estimated by fitting a non-parsimonious logistic regression model that included baseline socio-demographic and clinical characteristics. For each risk group, we estimated the odds ratio (OR) and 95% confidence (CI) of FTR, comparing AA to White children.Results: Of 276,917 children who underwent inpatient surgical procedure, 12,580 (4.5%) returned to the operating room. The rates of FTR in the low-risk and high-risk groups were 0.4% and 3.5%, respectively. Children in the high-risk and intermediate-high-risk groups (50% of cohort) accounted for 75.8% of non-survivors. Across the 4 risk-groups, children of AA race had a relative greater odds of FTR. Specifically, being AA relative to White was associated with a two-fold increase in the odds of FTR among high-risk children (OR: 2.29, 95%CI: 1.47, 3.58; P<0.001). In addition, being AA was associated with a relative increase in the odds of mortality in the intermediate risk groups (intermediate-low OR: 1.96; intermediate-high OR: 1.93). Among low risk children, the association was not statistically significant at the alpha level of 0.05.Conclusion: Being AA, relative to white, was positively associated with FTR following return to the operating room. Efforts to reduce these racial disparities should broaden the focus beyond the racial differences in preoperative comorbidity burden.
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