Black Children Have a Significantly Higher Risk of Dying from Post-Surgery Complications, Study Finds

African American children, even when healthy, have a notably higher risk of dying from postoperative complications compared to white children, according to a new study published in Pediatrics – the official journal of The American Academy of Pediatrics.

Race often plays a determining factor in surgical outcomes, and generally African Americans have higher rates of postoperative mortality compared to white counterparts. This disparity is attributable to black patients usually having more preoperative underlying conditions hindering them. The researcher authors noted that whether these established racial differences exist among apparently healthy children is unknown.

In this retrospective study, the researchers analyzed 172,549 apparently health children from the National Surgical Quality Improvement Program-Pediatric database from 2012 to 2017. They focused on identifying pediatric patients who underwent inpatient operations and were assigned a physical status either 1 or 2 by the American Society of Anesthesiologists (ASA) – statuses that categorize a patient’s operative risk based on their physical condition. The primary endpoint was defined as overall 30-day in-hospital postoperative mortality, while the secondary endpoints were overall 30-day postoperative complications and serious adverse events (SAEs).

Race ‘Strongly Associated’ with Poorer Surgical Outcomes

The results paint an unsettling picture. The researchers observed that African American children had 3.43 times higher odds of dying juxtaposed to white children following 30 days of surgery. Moreover, compared to white children, black children had an 18% relative greater odds of developing post-surgery complications.

“Generally, we expect that healthier patients should do well with surgeries. Healthy kids have low complication rates,” says Olubukola Nafiu, MD, FRCA, pediatric anesthesiologist and vice chair for Academic Affairs and Research at Nationwide Children’s Hospital and lead author of the study in a press release. “The expectation should be that complication rates and/or mortality among healthy children won’t vary based on racial category – what we found is that they do.”


“Importantly, we want to highlight that these findings are from observational data. Race doesn’t cause these outcomes, but it is strongly associated with them,” added Dr. Nafu. “Our next job is to look at what postoperative complications are driving the observed morbidity and mortality pattern in order to identify modifiable outcomes.”