Who faces poor urologic surgery outcomes?
Black children and those undergoing bladder or urinary diversions suffer the most pediatric urologic surgery complications, according to a new study published in Pediatrics. The researchers sought to understand in what circumstances and in what populations most urologic complications occur in an effort to advance quality improvement.
Quality improvement is an ongoing effort across healthcare, especially since the passage of the Affordable Care Act and the connection of reimbursements to quality care. Clinicians have been tasked with finding ways to reduce complications, but also to identify risk factors that can lead to adverse events. Race has been identified in a number of studies as a factor in a variety of medical conditions, and is an important risk factor in surgical readmission rates, complications, and morbidity.
In this study, data collected through the National Surgical Quality Improvement Program–Pediatrics (NSQIP-P) on nearly 115,000 national pediatric urology cases from more than 50 hospitals between 2012 and 2013 was analyzed to review 30-day postoperative complications. The analysis considered preoperative, intraoperative, and postoperative factors, as well as mortality and morbidity outcomes in both inpatient and outpatient cases. Included in the consideration of complications were surgical site infection (SSI), pneumonia, reintubation, renal insufficiency, urinary tract infection, venous thrombotic events, neurologic problems, graft failure, cardiac arrest, transfusion, sepsis, central line-associated bloodstream infection (CLABSI), unplanned readmission, and unplanned reoperation.
Patients were split into groups of non-Hispanic whites, non-Hispanic blacks, and “other” races, which included Hispanics, Asians, American Indians, and more. The analysis revealed that the overall complication rate of pediatric urologic surgeries was 5.9%. Bladder and urinary diversion accounted for the highest rates of 30-day complication, at 23% and 22%, respectively. Researchers also found that non-Hispanic black children and those undergoing renal and ureteral procedures had higher odds of having complications.
Non-Hispanic black children had a 34% greater chance of experiencing 30-day complications than non-Hispanic white children. Non-Hispanic black children also had a 53% higher chance of experiencing a hospital-acquired infection (HAI) in the postoperative period compared with non-Hispanic white children. Bladder and urinary diversions also were associated with higher HAI rates compared with testicular procedures.
“The public health implications of possible racial disparities in pediatric urologic complications certainly warrant additional exploration,” the researchers note. “One possible explanation is that black children may be more likely to receive care at hospitals with fewer resources, which may drive the association between race and outcomes.”