
Race, postoperative complications, and death in apparently healthy children - BlameKaneda
https://pediatrics.aappublications.org/content/pediatrics/early/2020/07/16/peds.2019-4113.full.pdf
======
BlameKaneda
"BACKGROUND: That African American (AA) patients have poorer surgical outcomes
compared with their white peers is established. The prevailing presumption is
that these disparities operate within the context of a higher preoperative
comorbidity burden among AA patients. Whether these racial differences in
outcomes exist among apparently healthy children (traditionally expected to
have low risk of post surgical complications) has not been previously
investigated."

"CONCLUSIONS: Even among apparently healthy children, being AA is strongly
associated with a higher risk of postoperative complications and mortality.
Mechanisms underlying the established racial differences in postoperative
outcomes may not be fully explained by the racial variation in preoperative
comorbidity."

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ojnabieoot
This caveat in the discussion highlights an important area of policy and
research for the impact of structural racism:

> We also acknowledge that we did not explore the site of care where these
> patients received their surgeries given that previous investigators have
> shown that minority patients tend to receive care in low-quality, minority-
> serving hospitals. Site of care is a critical variable that appears to
> mediate the pathway of the association of race with postoperative morbidity
> and mortality. Unfortunately, the [National Surgical Quality Improvement
> Program-Pediatrics] program strongly discourages attempts to identify
> specific hospitals in the database. Given that site of care is an important
> potentially modifiable variable and the established knowledge that
> disparities in surgical care is a pervasive and long-standing problem in our
> health care system, improving access to high-quality care across every
> hospital is an important step to reduce the persistent racial disparity in
> health outcomes in the US.

But let's not forget that many American doctors, individually, are despicable
racists who treat black children worse than animals[1]:

> An estimated 0.94 (95% CI, 0.78-1.10) million children were diagnosed as
> having appendicitis. Of those, 56.8% (95% CI, 49.8%-63.9%) received
> analgesia of any type; 41.3% (95% CI, 33.7%-48.9%) received opioid analgesia
> (20.7% [95% CI, 5.3%-36.0%] of black patients vs 43.1% [95% CI, 34.6%-51.4%]
> of white patients). When stratified by pain score and adjusted for
> ethnicity, black patients with moderate pain were less likely to receive any
> analgesia than white patients (adjusted odds ratio = 0.1 [95% CI,
> 0.02-0.8]). Among those with severe pain, black patients were less likely to
> receive opioids than white patients (adjusted odds ratio = 0.2 [95% CI,
> 0.06-0.9]). In a multivariable model, there were no significant differences
> in the overall rate of analgesia administration by race. However, black
> patients received opioid analgesia significantly less frequently than white
> patients (12.2% [95% CI, 0.1%-35.2%] vs 33.9% [95% CI, 0.6%-74.9%],
> respectively; adjusted odds ratio = 0.2 [95% CI, 0.06-0.8]).

And that many American doctors are plain racist cranks[2]:

> Study 2 demonstrates that, similar to white laypersons in study 1, many
> white medical students and residents hold beliefs about biological
> differences between blacks and whites, many of which are false and
> fantastical in nature, and that these false beliefs are related to racial
> bias in pain perception. Furthermore, study 2 also reveals that white
> medical students and residents who endorsed false beliefs showed racial bias
> in the accuracy of their pain treatment recommendations. Specifically,
> participants who endorsed more of these beliefs reported that a black (vs.
> white) target patient would feel less pain and they were less accurate in
> their treatment recommendations for the black (vs. white) patient. Although
> the effect sizes for these findings were not large (η2p = 0.03 and 0.04),
> the practical importance is significant: those endorsing more false beliefs
> rated the pain of a black (vs. white) patient half a scale point lower and
> were less accurate in their treatment recommendations 15% of the time.

[1] [https://jamanetwork.com/journals/jamapediatrics/article-
abst...](https://jamanetwork.com/journals/jamapediatrics/article-
abstract/2441797) [2]
[https://www.pnas.org/content/113/16/4296](https://www.pnas.org/content/113/16/4296)

~~~
opwieurposiu
The unstated premise that more opioids = better care is questionable at best.
In fact is likely that the opposite is true.

~~~
wittyreference
> black patients with moderate pain were less likely to receive any analgesia
> than white patients (adjusted odds ratio = 0.1 [95% CI, 0.02-0.8]).

90% less likely to receive _any_ pain-relieving medication. That's well beyond
the gray area of "how much opioids should we give, more or less?"

~~~
opwieurposiu
> In a multivariable model, there were no significant differences in the
> overall rate of analgesia administration by race.

~~~
wittyreference
> There was no statistically significant difference in _overall analgesia_
> administration by race, _but there was a statistically significant
> difference in opioid administration by race_. Black children with
> appendicitis were less likely to receive opioid analgesia than white
> children (12.2% [95% CI, 0.1%-35.2%] vs 33.9% [95% CI, 0.6%-74.9%],
> respectively; adjusted OR = 0.2 [95% CI, 0.06-0.8]). No other covariates
> achieved statistical significance in the multivariable model.

There difference between "any analgesia" and "opioids" in the pediatric
population is almost entirely "ibuprofen." There was no difference in the
administration of ibuprofen.

