Surgical Mortality and Race as a Risk Factor: A Compass, Not a Destination

Remarkably, few national estimates of inpatient pediatric surgical mortality have been published.1 Pediatric inpatient mortality has been reported mostly for cardiovascular and neurosurgical procedures.2,3 In this issue of Pediatrics , Akbilgic et al4 broaden and extend this literature by examining 30-day postoperative mortality for more than 260 000 surgical procedures performed on children from 2012 to 2015. By using a novel approach, network analysis, and classification trees, the authors developed race-specific models using preoperative risk factors to predict 30-day surgical mortality for African-American versus white children. Risk factors such as ventilator use, oxygen support, wound infections, transfusions, and neonatal status were more prevalent in African-American children and positively associated with death after surgery. Moreover, risk factors more prevalent in white children (eg, sepsis, malignancy, emergent case status) carried a higher risk of death when present in African-American children.4 Although this study lacked data about social and structural risk factors, which are often experienced differentially among racial groups and known to contribute to overall health outcomes and mortality, race-specific risk models may have implications for surgical practice. For example, surgical teams might use the models … Address correspondence to Nia Heard-Garris, MD, MSc, Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 Chicago Ave, Box 162, Chicago, IL 60611. E-mail: nheardgarris{at}luriechildrens.org