Department of Anesthesiology and Pain Medicine
College of Medicine, The Ohio State University, Columbus, Ohio.
Pediatrics. 2021 Oct;148(4). doi: 10.1542/peds.2021-051328. Epub 2021 Sep 16.
Despite unparalleled advances in perioperative medicine, surgical outcomes remain poor for racial minority patients relative to their white counterparts. Little is known about the excess costs to the health care system related to these disparities.
We performed a retrospective analysis of data from the Nationwide Inpatient Sample between 2001 and 2018. We included children younger than 18 years admitted with appendicitis who underwent an appendectomy during their hospital stay. We examined the inflation-adjusted hospital costs attributable to the racial disparities in surgical complications and perforation status, focusing on differences between non-Hispanic white patients and non-Hispanic Black patients.
We included 100 639 children who underwent appendectomy, of whom 89.9% were non-Hispanic white and 10.1% were non-Hispanic Black. Irrespective of perforation status at presentation, surgical complications were consistently higher for Black compared with white children, with no evidence of narrowing of the racial disparity gap over time. Black children consistently incurred higher hospital costs (median difference: $629 [95% confidence interval: $500-$758; < .01). The total inflation-adjusted hospital costs for Black children were $518 658 984, and $59 372 044 (11.41%) represented the excess because of the racial disparities in perforation rates.
Although all patients had a progressive decline in post appendectomy complications, Black children consistently had higher rates of complications and perforation, imposing a significant economic burden. We provide an empirical economic argument for sustained efforts to reduce racial disparities in pediatric surgical outcomes, notwithstanding that eliminating these disparities is simply the right thing to do.
尽管围手术期医学取得了无与伦比的进步，但与白人患者相比，少数族裔患者的手术结果仍然较差。对于与这些差异相关的医疗保健系统的额外成本知之甚少。
我们对 2001 年至 2018 年期间全国住院患者样本中的数据进行了回顾性分析。我们纳入了年龄在 18 岁以下因阑尾炎住院并在住院期间接受阑尾切除术的儿童。我们检查了手术并发症和穿孔状态的种族差异导致的通胀调整后医院成本，重点关注非西班牙裔白人和非西班牙裔黑人间的差异。
我们纳入了 100639 名接受阑尾切除术的儿童，其中 89.9%是非西班牙裔白人，10.1%是非西班牙裔黑人。无论穿孔状态如何，黑人儿童的手术并发症始终高于白人儿童，而且随着时间的推移，种族差异差距并没有缩小的迹象。黑人儿童的住院费用始终较高（中位数差异：$629 [95%置信区间：$500-$758; <.01）。黑人儿童的总通胀调整后医院费用为$518658984，$59372044（11.41%）是由于穿孔率的种族差异而产生的超额费用。
尽管所有患者的阑尾切除术后并发症都呈逐渐下降趋势，但黑人儿童的并发症和穿孔率始终较高，这给他们带来了巨大的经济负担。我们提供了一个经验性的经济论据，证明需要持续努力减少儿科手术结果中的种族差异，尽管消除这些差异只是正确的做法。
