Departments of Anesthesiology and Pain Medicine.
Ohio State University College of Medicine, Columbus, Ohio.
Pediatrics. 2023 May 1;151(5). doi: 10.1542/peds.2022-058774.
Postoperative pneumonia is the third most common surgical complication and can seriously impair surgical rehabilitation and lead to related morbidity and mortality. We evaluated the temporal trends in racial and ethnic disparities in postoperative pneumonia and quantified the economic burden resulting from these inequalities in the United States.
This population-based study includes 195 028 children (weighted to 964 679) admitted for elective surgery across 5340 US hospitals reporting to the Nationwide Inpatient Sample between 2010 and 2018. We estimated the risk-adjusted incidence of postoperative pneumonia, comparing racial and ethnic groups. We also quantified the inflation-adjusted hospital costs attributable to racial and ethnic disparities in postoperative pneumonia.
The risk-adjusted rates of pneumonia declined across all racial and ethnic categories, with Black children having the lowest annual rate of decline (Black: 0.03 percentage points, Hispanic: 0.05 percentage points, white: 0.05 percentage points). The risk-adjusted rates of pneumonia trended consistently higher for Black and Hispanic children, relative to white children, throughout the study period (Black versus white: relative risk, 1.31 (95% confidence interval, 1.14-1.51), P < .01; Hispanic versus white: relative risk, 1.16 (95% confidence interval, 1.02-1.32), P = .02). These disparities did not narrow significantly over time. During the study period, the excess hospitalization cost attributable to racial and ethnic disparities in postoperative pneumonia was $24 533 458 for Black children and $26 200 783 for Hispanic children (total, $50 734 241).
Against the backdrop of decreasing postoperative pneumonia, Black and Hispanic children continue to experience higher rates compared with white children. These persistent disparities in postoperative pneumonia were associated with considerable excess cost of surgical care.
术后肺炎是第三大常见手术并发症，可严重影响手术康复并导致相关发病率和死亡率。我们评估了美国术后肺炎的种族和民族差异的时间趋势，并量化了这些不平等现象导致的经济负担。
这项基于人群的研究包括 2010 年至 2018 年期间向全国住院患者样本报告的 5340 家美国医院收治的 195028 名（加权至 964679 名）择期手术儿童。我们比较了不同种族和民族群体，估计了术后肺炎的风险调整发病率。我们还量化了归因于术后肺炎的种族和民族差异的通胀调整后的医院成本。
所有种族和民族类别的肺炎风险调整率均下降，黑人儿童的年下降率最低（黑人：0.03 个百分点，西班牙裔：0.05 个百分点，白人：0.05 个百分点）。在整个研究期间，黑人儿童和西班牙裔儿童的肺炎风险调整率始终高于白人儿童（黑人与白人相比：相对风险，1.31（95%置信区间，1.14-1.51），P < 0.01；西班牙裔与白人相比：相对风险，1.16（95%置信区间，1.02-1.32），P = 0.02）。这些差异并没有随着时间的推移而显著缩小。在研究期间，黑人儿童和西班牙裔儿童因术后肺炎的种族和民族差异而导致的住院费用过高，分别为 24533458 美元和 26200783 美元（总计 50734241 美元）。
尽管术后肺炎的发生率有所下降，但与白人儿童相比，黑人和西班牙裔儿童的发病率仍然较高。术后肺炎的这些持续存在的差异与手术护理的大量额外费用有关。
