Non-white children and neonates who undergo cardiac surgery are at greater risk for mortality and longer postoperative length of hospital stay, a new analysis from the Pediatric Health Information System Database shows. This manuscript was published Wednesday online in JACC: Advances by Shaun P. Setty, MD, of MemorialCare Heart and Vascular Institute and MemorialCare Children’s and Women’s Hospital, Long Beach, California, and colleagues. Studies using the RACHS-1 (Risk Adjustment for Congenital Heart Surgery-1) and Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery complexity scoring system have shown that discharge mortality for pediatric cardiac surgery patients was around 3% from 2000 to 2012. Many minority groups experience additional socioeconomic barriers to care and good health before and after surgery. This present retrospective, multicenter, cross-sectional cohort study utilized the RACHS-2 model, which has been validated by two individual administrative databases, and compared it to clinical registry data to assess gaps in disparities in pediatric cardiac surgery. Pediatric cardiac surgery patients were identified using the Pediatric Health Information System (PHIS) Database, and patients included underwent cardiac surgery between October 2015 through December 2020. Case complexity was determined by the RACHS-2 system. A total of 59,856 patients (median age=7.4 months; 60.6% white, 39.4% non-white, 18.2% Hispanic ethnicity) were included in this study. Patients were categorized into low (n=38,927), medium (n=9,833), and high (n=11,106) risk. Overall hospital mortality was 3% and overall postoperative length of stay (LOS) was 7 days. Mortality and postoperative LOS increased as RACHS-2 risk scores increased. The factors most significantly associated with increased mortality rates were mechanical ventilation, extracorporeal membrane oxygenation, infection and surgical complications (p<0.008). After controlling for these variables, along with RACHS-2 score, age upon surgery and emergency admission, multivariable analyses demonstrated that non-white race was associated with increased mortality rates (relative risk=1.2; 95% confidence interval [CI]=0.729-0.955; p=0.008). Non-white race was also associated with longer LOS by 1.04 days (95% CI=0.95-0.97; p<0.001). Both clinical outcomes were also greater in non-white neonates (mortality relative risk=1.3, 95% CI=1.1-1.6, p=0.003; postoperative LOS by 2.5 weeks, 95% CI=1.36-3.10, p<0.001). The investigators in this study did note some limitations. First, clinical parameters of the PHIS database may have impacted care and clinical outcomes; for example, income and economic status were not reported. Additionally, all pediatric cardiac surgery patients were included, so these results may not be applicable to specific populations or surgical procedure. Overall, non-white pediatric patients and neonates who underwent cardiac surgery were at greater risk for mortality and longer LOS. In-depth studies in special cardiac surgery populations will help improve outcomes and eliminate racial disparities in care. Source: Setty SP, Reynolds LC, Chou VC, et al. Racial Health Disparity Associated With Poor Pediatric Cardiac Surgery Outcomes: A Multicentered, Cross-Sectional Study. JACC Adv. 2024 June 12 (Article in Press). Image Credit: Julian – stock.adobe.com