What a Study on Post-Op Complications Does and Doesn't Tell Us About Racial Disparities

By Rhea Body, MD, MPH
August 28, 2020
In early August, there was a particularly disturbing study published in Pediatrics entitled, “Race, Postoperative Complications, and Death in Apparently Healthy Children,” by Olubukola Nafiu, Christian Mpody, Stephani Kim, Joshua Uffman and Joseph Tobias.
The study finds, among other things, that reportedly healthy African American children have a higher risk of having complications and dying within 30 days after surgery compared to reportedly healthy white children. Deaths were very rare overall (less than .1% of all kids studied), but African American kids had a 3.5 times greater risk of dying than white kids. This is particularly relevant given that racial disparities in health are often attributed to higher comorbidities among African American patients. The results show an association, not a causal relationship, but they offer another illustration of how structural racism could lead to poor outcomes even for kids and those deemed otherwise healthy.

I also selected this study because there are a few things it does not tell us that are critical for intervention and prevention of this horrible inequity. First, we don’t know which hospitals have the worst outcomes for African American children — that information that is anonymized in the national database used by the authors. Second, we don’t know if there are racial differences in post-operative mortality rates by type of surgery. The paper doesn’t touch on this and may also be a function of the national database used by the authors.

Knowing this information could draw greater attention to the structural drivers of inequity within these institutions and specialties. It would also equip families with vital information that may shape their willingness to undergo certain procedures and which facilities they avoid.

Anonymizing hospitals and surgical specialties may increase the reporting frequency of adverse events like post-surgical complications and deaths. But doing so also prevents direct action that could remedy the greatest offenders and can obscure the mechanisms by which structural racism is shortening people’s lives.

Rhea Boyd is a pediatrician, public health advocate and scholar. Her work focuses on the relationship between structural racism, health and inequity.

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