The effect of race and gender on pediatric surgical outcomes within the United States

J Pediatr Surg. 2013 Aug;48(8):1650-6. doi: 10.1016/j.jpedsurg.2013.01.043.


Purpose: The purpose of this study was to examine risk-adjusted associations between race and gender on postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States.

Methods: 101,083 pediatric surgical patients were evaluated using the U.S. national KID Inpatient Database (2003 and 2006): appendectomy (81.2%), pyloromyotomy (9.8%), intussusception (6.2%), decortication (1.9%), congenital diaphragmatic hernia repair (0.7%), and colonic resection for Hirschsprung's disease (0.2%). Patients were stratified according to gender (male: 63.1%, n=63,783) and race: white (n=58,711), Hispanic (n=26,118), black (n=9,103), Asian (n=1,582), Native American (n=474), and other (n=5,096). Multivariable logistic regression modeling was utilized to evaluate risk-adjusted associations between race, gender, and outcomes.

Results: After risk adjustment, race was independently associated with in-hospital death (p=0.02), with an increased risk for black children. Gender was not associated with mortality (p=0.77). Postoperative morbidity was significantly associated with gender (p<0.001) and race (p=0.01). Gender (p=0.003) and race (p<0.001) were further associated with increased hospital length of stay. Importantly, these results were dependent on operation type.

Conclusion: Race and gender significantly affect postoperative outcomes following pediatric surgery. Black patients are at disproportionate risk for postoperative mortality, while black and Hispanic patients have increased morbidity and hospital resource utilization. While gender does not affect mortality, gender is a determinant of both postoperative morbidity and increased resource utilization.

Keywords: Gender; Pediatric surgery outcomes; Race.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Continental Population Groups / statistics & numerical data*
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Health Resources / statistics & numerical data
  • Hospital Charges / statistics & numerical data
  • Hospital Mortality
  • Hospitals, Teaching
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Infant
  • Infant, Newborn
  • Insurance Coverage / statistics & numerical data
  • Intraoperative Complications / epidemiology
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Pediatrics / statistics & numerical data*
  • Postoperative Complications / epidemiology
  • Risk Factors
  • Sex Factors*
  • Socioeconomic Factors
  • Specialties, Surgical / statistics & numerical data*
  • Surgical Procedures, Operative / economics
  • Surgical Procedures, Operative / statistics & numerical data*
  • Treatment Outcome
  • United States / epidemiology