Why Do Black Kids Fare Worse After Surgery?

Black children were also more likely to have bleeding severe enough to require a transfusion: Almost 10% did, versus about 7% of white children.

The biggest difference was seen in the risk of death — which, though very low, was more than three times higher among Black children.

It’s not clear why, but the higher rates of adverse events might be one reason, Nafiu said. If further studies can link particular complications to that heightened risk of death, he added, then hospitals and surgery staff can try to do something about it.

But why were Black children at greater risk of complications in the first place? The study suggests underlying health problems are not to blame, but it cannot pinpoint the true reasons.

One possibility is the site of care, said Dr. Jean Leclerc Raphael, director of the Center for Child Health Policy and Advocacy at Baylor College of Medicine in Houston.

Research shows that compared to white people, minorities in the United States often receive care at lower-performing hospitals.

Due to income and insurance coverage, Raphael explained, Black families may be limited in their options for hospital care.

That matters because surgery outcomes may be better, for example, at higher-volume hospitals. “If my hospital does 100,000 procedures for appendicitis a year,” Raphael said, “the surgeons have much more experience, given the volume, than a hospital where 100 procedures for appendicitis are done a year.”

Since this study did not look at hospital factors, he said, it’s not clear if they would help explain the racial disparities.

Bias could also be involved, Raphael said. As an example, he noted, several studies have found that doctors are more likely to “downplay pain from minority patients.”

Like Nafiu, Raphael emphasized that the absolute risks of death were very low among these children.

“It’s also important to state that these are complex questions,” he said. “Having more information on site of care would be helpful, as hospital characteristics are critical in determining why these differences occur.”

The findings are based on records from a national database tracking pediatric surgery outcomes. Nafiu’s team focused on 172,549 healthy children who had surgery between 2012 and 2017 — including orthopedic, abdominal and brain/spinal procedures. Heart surgeries were excluded, Nafiu said.