Medical Student University of Texas Southwestern Medical School Dallas, Texas
Introduction: Although socioeconomic disparities in access to pediatric surgical care are widely documented, differences in surgical outcomes are less comprehensively known. We conducted a scoping review to understand disparate outcomes in pediatric surgical care.
Methods: We searched the PubMed database using both standard terminology and keywords along with Medical Subject Heading (MeSH) to identify studies that analyzed disparities in outcomes based on sociodemographic factors. We included studies published between 1/2011 and 6/2021. Studies were excluded if not written in the English language, conducted outside of the U.S., conducted without human subjects (e.g., review article), lacked written abstract or full text article, had majority of subjects >18 years, or reported disparities unrelated to sociodemographic factors or surgical outcomes. Two authors individually reviewed titles and abstracts to determine final inclusion.
Results: Of 969 articles identified, 50 (5%) were included. Studies addressed disparities in disease-specific outcomes (N=21, 42%, e.g. persistent sleep apnea), perioperative adverse events (N=15, 30%, e.g. respiratory events after tonsillectomy), short-term postoperative mortality (N=15, 30%) length of stay (N=14, 28%), revisits (N=5, 10%), long-term postoperative mortality (N=4, 8%), and intensity of care (N=3,6%)). Studies reported disparities related to Black race (N=31, 62%), Hispanic ethnicity (N=15, 30%). socioeconomic status (N=15, 30%) or insurance status (N=15, 30%). Seven studies (14%) reported disparities in otolaryngology outcomes, including adenotonsillectomy and cochlear implantation. Although conclusions were broad, common study findings showed that children in racial/ethnic and socioeconomic minorities may have worse postoperative surgical outcomes in all outcome types assessed.
Conclusion: Children with minority race and ethnicity or low socioeconomic status generally experience worse outcomes after surgery. Distinguishing social determinants of disparities in disease-specific outcomes from those resulting from weaknesses in perioperative health systems delivery may improve health equity in pediatric surgical care.