Racial Disparities in Pediatric Endoscopic Sinus Surgery

Laryngoscope. 2021 Apr;131(4):E1369-E1374. doi: 10.1002/lary.29047. Epub 2020 Sep 4.


Objective: To determine the impact of race and ethnicity on 30-day complications following pediatric endoscopic sinus surgery (ESS).

Study design: Cross-sectional cohort study.

Subjects and methods: Patients ≤ 18 years of age undergoing ESS from 2015 to 2017 were identified in the Pediatric National Surgical Improvement Program-Pediatric database. Patient demographics, comorbidities, surgical indication, and postoperative complications were extracted. Patient race/ethnicity included non-Hispanic black, non-Hispanic white, Hispanic, and other. Multivariable logistic regression was performed to determine if race/ethnicity was a predictor of postoperative complications after ESS.

Results: A total of 4,337 patients were included in the study. The median age was 10.9 (interquartile range: 14.5-6.7) years. The cohort was comprised of 68.3% non-Hispanic white, 13.9% non-Hispanic black, 9.7% Hispanic, and 2.1% other. The 30-day complication rate was 3.2%, and the mortality rate was 0.3%. The rate of reoperation was 3.8%, and readmission was 4.1%. Black and Hispanic patients had higher rates of urgent operations (P = .003 and P < .001, respectively), and black patients had a higher incidence of emergent operations (P < .001) compared to their white peers. For elective ESS cases, multivariable analysis adjusting for sex, age, comorbidities, and surgical indication indicated that children of Hispanic ethnicity had increased postoperative complications (odds ratio: 1.57, 95% confidence interval: 1.04-2.37).

Conclusion: This analysis demonstrated that black and Hispanic children disproportionately undergo more urgent and emergent ESS. Hispanic ethnicity was associated with increased 30-day complications following elective pediatric ESS. Further studies are needed to elucidate potential causes of these disparities and identify areas for improvement.

Level of evidence: 3 Laryngoscope, 131:E1369-E1374, 2021.

Keywords: Endoscopic sinus surgery; NSQIP; complications; disparities; ethnicity; pediatric; race.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Black or African American
  • Child
  • Child, Preschool
  • Comorbidity
  • Cross-Sectional Studies
  • Elective Surgical Procedures / adverse effects
  • Elective Surgical Procedures / statistics & numerical data
  • Endoscopy / methods*
  • Endoscopy / statistics & numerical data
  • Ethnicity
  • Female
  • Hispanic or Latino
  • Humans
  • Logistic Models
  • Male
  • Nasal Surgical Procedures / adverse effects*
  • Outcome Assessment, Health Care
  • Paranasal Sinuses / surgery*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / ethnology
  • Racism / ethnology*
  • Reoperation / statistics & numerical data
  • White People