From the Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
Anesth Analg. 2021 Mar 1;132(3):679-685. doi: 10.1213/ANE.0000000000005329.
Failure to rescue (FTR) and unplanned reoperation following an index surgical procedure are key indicators of the quality of surgical care. Given that differences in unplanned reoperation and FTR rates among racial groups may contribute to persistent disparities in postsurgical outcomes, we sought to determine whether racial differences exist in the risk of FTR among children who required unplanned reoperation following inpatient surgical procedures.
We used the National Surgical Quality Improvement database (2012-2017) to assemble a cohort of children (<18 years), who underwent inpatient surgery and subsequently returned to the operating room within 30 days of the index surgery. We used logistic regression models to estimate the odds ratio (OR) and 95% confidence interval (CI) of FTR, comparing African American (AA) to White children. We estimated the risk-adjusted odds ratio (aOR) for FTR by controlling the analyses for demographic characteristics, surgical profile, and preoperative comorbidities. We further evaluated the racial differences in FTR by stratifying the analyses by the timing of unplanned reoperation.
Of 276,917 children who underwent various inpatient surgical procedures, 10,425 (3.8%) required an unplanned reoperation, of whom 2016 (19.3%) were AA and 8409 (80.7%) were White. Being AA relative to being White was associated with a 2-fold increase in the odds of FTR (aOR: 2.03; 95% CI, 1.5-2.74; P < .001). Among children requiring early unplanned reoperation, AAs were 2.38 times more likely to die compared to their White peers (8.9% vs 3.4%; aOR: 2.38; 95% CI, 1.54-3.66; P < .001). In children with intermediate timing of return to the operating room, the risk of FTR was 80% greater for AA children compared to their White peers (2.2% vs 1.1%; aOR: 1.80; 95% CI, 1.07-3.02; P = .026). Typically, AA children die within 5 days (interquartile range [IQR]: 1-16) of reoperation while their White counterparts die within 9 days following reoperation (IQR: 2-26).
Among children requiring unplanned reoperation, AA patients were more likely to die than their White peers. This racial difference in FTR rate was most noticeable among children requiring early unplanned reoperation. Time to mortality following unplanned reoperation was shorter for AA than for White children. Race appears to be an important determinant of FTR following unplanned reoperation in children and it should be considered when designing interventions to optimize unplanned reoperation outcomes.
手术失败（FTR）和计划外再次手术是手术质量的关键指标。由于不同种族群体之间计划外再次手术和 FTR 率的差异可能导致手术后结果的持续差异，因此我们试图确定在因住院手术而需要计划外再次手术的儿童中，FTR 的风险是否存在种族差异。
我们使用国家手术质量改进数据库（2012-2017 年），组建了一个队列，其中包括接受住院手术且术后 30 天内返回手术室的儿童（<18 岁）。我们使用逻辑回归模型来估计 FTR 的优势比（OR）和 95%置信区间（CI），并将非裔美国人（AA）与白人儿童进行比较。我们通过控制分析人口统计学特征、手术特征和术前合并症来估计 FTR 的风险调整优势比（aOR）。我们还通过按计划外再次手术的时间分层分析来进一步评估 FTR 中的种族差异。
在接受各种住院手术的 276917 名儿童中，有 10425 名（3.8%）需要计划外再次手术，其中 2016 名（19.3%）为 AA，8409 名（80.7%）为白人。与白人相比，AA 发生 FTR 的几率增加了两倍（aOR：2.03；95%CI，1.5-2.74；P<0.001）。在需要早期计划外再次手术的儿童中，AA 发生死亡的几率是其白人同龄人的 2.38 倍（8.9%比 3.4%；aOR：2.38；95%CI，1.54-3.66；P<0.001）。在返回手术室时间处于中间的儿童中，AA 发生 FTR 的风险比其白人同龄人高 80%（2.2%比 1.1%；aOR：1.80；95%CI，1.07-3.02；P=0.026）。通常情况下，AA 儿童在手术后 5 天内（四分位距 [IQR]：1-16）死亡，而他们的白人同龄人则在手术后 9 天内死亡（IQR：2-26）。
在需要计划外再次手术的儿童中，AA 患者死亡的几率高于白人同龄人。在需要早期计划外再次手术的儿童中，FTR 率的这种种族差异最为明显。AA 儿童在计划外再次手术后的死亡时间比白人儿童短。种族似乎是儿童计划外再次手术后 FTR 的一个重要决定因素，在设计优化计划外再次手术结果的干预措施时应予以考虑。
