Racial Disparities in Pediatric Anesthesia

Baetzel, Anne; Holman, Ashlee E.; Dobija, Nicole; Reynolds, Paul I.; Nafiu, Olubukola O.

doi:10.1016/j.anclin.2020.01.010

Cited by 19 publications

(15 citation statements)

References 45 publications

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“…Studies have shown that the older the child, the lower the incidence of adverse events, especially in children under 12 years of old. Experienced pediatric anesthesiologists can also reduce the risk of adverse events (6)(7)(8)(9). Timely treatment of adverse events, such as airway obstruction caused by mucosal edema and tongue drop and perioperative hypothermia, is essential for the preservation of life.…”

Section: Introductionmentioning

confidence: 99%

Identification of the risk factors in perioperative respiratory adverse events in children under general anesthesia and the development of a predictive model

et al. 2021

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Background: This study explored the risk factors of perioperative respiratory adverse events in children under 12 years old undergoing general anesthesia surgery. A prediction model was constructed according to the related risk factors to provide a basis for timely clinical intervention and decision-making.Methods: Children under 12 years old who underwent general anesthesia in our hospital between January 2016 and December 2020 were included in this study. The clinical data, including age, gender, weight, American Society of Anesthesiologists (ASA) grade classification, operation season, preoperative hospital stay, anesthesia time, and postoperative pain score, were collated. Continuous variables were converted to categorical variables. Logistic regression analysis was used to screen independent risk factors and a nomogram was constructed to predict the probability of adverse events. Fitting curves and receiver operating characteristic (ROC) curves were utilized to verify the model.Results: Logistic regression analyses demonstrated that age [odds ratio (OR) =1.32, 95% confidence interval (CI): 1.08 to 1.49], body weight (OR =1.49, 95% CI: 1.21 to 1.84), anesthesia time (OR =1.61, 95% CI: 1.32 to 1.78), and surgery season (OR =1.12, 95% CI: 1.07 to 1.39) were independent risk factors for respiratory adverse events in children undergoing general anesthesia (P<0.05). The risk of respiratoryrelated adverse events increased in children with grade II ASA classification compared to children with grade I ASA classification (P<0.05). Similarly, the risk of respiratory adverse events increased in children with level III pain scores compared to children with level I pain scores (P<0.05). The calibration curve showed that the predicted curve was consistent with the actual curve. The area under the ROC curve (AUC) was 0.707, indicating that model showed great predictive ability.Conclusions: Age, weight, anesthesia time, operation season, ASA grade, and pain score were identified as independent risk factors for respiratory adverse events in children undergoing general anesthesia. Using the above risk factors, a nomogram was established to predict the risk of respiratory system-related adverse events. The predicted results were highly consistent with the actual risk, and the false positive rate was within a reasonable range.

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Section: Introductionmentioning

confidence: 99%

Identification of the risk factors in perioperative respiratory adverse events in children under general anesthesia and the development of a predictive model

et al. 2021

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“…12 The study done by Guedj and colleagues was powered to detect a significant difference between the cohorts unlike many of the other retrospective studies which consisted of small sample sizes and lacked power analyses. 12,24 There is a paucity of published data investigating the relationship between race and postoperative outcomes after pediatric orthopaedic surgery, but several studies do exist. These studies investigated hospitalization rate for septic arthritis, rate of implant removal after internal fixation of femoral shaft fractures, and postoperative outcomes following posterior spinal fusion.…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective and observational studies have been done looking at the administration of analgesics to pediatric patients, the results of which showed no clear consensus. Some studies have found no difference between opioid administration based on race or ethnicity while other studies did report significant differences 24. Guedj and colleagues found that African American and Hispanic children report higher pain scores but were provided fewer opioid analgesics when compared with White pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Dodwell and colleagues examined the rate of implant removal, including, plates, screws, and intramedullary nails, following internal fixation of femoral shaft fractures. They found that pediatric patients who were younger, White, and from higher socioeconomic neighborhoods were more likely to have the implants removed among all the pediatric patients analyzed despite having an equal need for removal of implants 24. They hypothesized that the differences are because of disparities in care based on demographic and socioeconomic status, as well as differences in insurance coverage.…”

Section: Discussionmentioning

confidence: 99%

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Racial Disparities in Postoperative Outcomes Following Operative Management of Pediatric Developmental Dysplasia of the Hip

Malyavko

Quan

Howard

et al. 2022

Journal of Pediatric Orthopaedics

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“…1 The same pattern has been found in the pediatric population. 2,3 Studies have found that Black children have higher rates of mortality, postoperative complications, and serious adverse events than White children, even when controlling for preoperative risk factors like comorbidities, age, and emergent status. [4][5][6][7][8][9][10] While much work is needed to better define underlying causes, we also need to identify effective approaches to reducing these disparities in outcomes.…”

Section: Introductionmentioning

confidence: 99%

Association between implementation of a coordinated care pathway in idiopathic scoliosis patients and a reduction in perioperative outcome disparities

Merced¹,

Colon²,

Mirzada³

et al. 2021

Pediatric Anesthesia

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Background There are well‐documented racial and ethnic disparities in treatment and perioperative outcomes for patients with adolescent idiopathic scoliosis. Aims We hypothesize that the implementation of a coordinated care pathway for pediatric patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis may be associated with a reduction in racial and ethnic disparities in perioperative outcomes. Methods This is a retrospective pre‐ and post‐test cohort study of patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis at our institution between July 1, 2013 and August 5, 2019. We implemented a coordinated care pathway in March 2015. Patient demographics included age, race, ethnicity, weight, gender, insurance status, ASA class, time between the date surgery was ordered and the date surgery occurred, degree of scoliosis, and the number of spinal levels fused. The primary outcome was length of stay. The secondary outcomes included transfusion rates, pain scores, and postoperative complications. Multivariable regression models compared outcome medians across race/ethnicity. Disparities were defined as the difference in adjusted outcomes by race/ethnicity. Results Four hundred twenty‐four patients underwent posterior spinal fusion for adolescent idiopathic scoliosis at our institution (116 prepathway and 308 postpathway). The median length of stay of Black patients was 1.0 day (95% CI: 0.4, 1.5; p = .006) longer than White patients prepathway. Prepathway patients who self‐identified as Other had a 1.2 (95% CI: 0.5, 1.9; p = .004) higher median average pain score on postoperative day 1 compared with White patients. On postoperative day 2, patients who identified as Other had 2.0 (95% CI: 0.8, 3.2; p = .005) higher pain score compared with White patients prepathway. Postpathway, there were no significant differences in outcomes by race/ethnicity. Conclusions Our study supports the hypothesis that use of a coordinated care pathway is associated with a reduction in racial and ethnic disparities in length of stay and pain scores in pediatric patients undergoing posterior spinal fusion.

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Racial Disparities in Pediatric Anesthesia

Cited by 19 publications

References 45 publications

Identification of the risk factors in perioperative respiratory adverse events in children under general anesthesia and the development of a predictive model

Identification of the risk factors in perioperative respiratory adverse events in children under general anesthesia and the development of a predictive model

Racial Disparities in Postoperative Outcomes Following Operative Management of Pediatric Developmental Dysplasia of the Hip

Association between implementation of a coordinated care pathway in idiopathic scoliosis patients and a reduction in perioperative outcome disparities

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