Black children suffer ‘more complications’ after appendicitis surgery
A study has found that black children in Britain are four times more likely to suffer complications after appendicitis surgery than their white counterparts.
The study, funded by the Association of Pediatric Anesthetists of Great Britain and Ireland, examined 2,799 children under the age of 16 from 80 hospitals in the UK who had undergone surgery for suspected appendicitis between November 2019 and January 2022.
Of these, 185 children (7%) developed postoperative complications within 30 days after surgery. Three quarters of these complications were wound related, while a quarter were airway, urinary tract or catheter related or of unknown origin.
The study found that black children had a four times greater risk of complications after surgery, and that this risk was independent of the child’s socioeconomic status and health history.
Appendicitis is one of the most common surgical emergencies in children; 10,000 are performed annually. The authors said this was the first study to look at demographic differences in the rate of postoperative complications related to appendicitis.
The researchers said they could not draw firm conclusions about why black children had worse outcomes after these types of emergency surgeries, and that this apparent health disparity “urgently requires further research and the development of solution-oriented interventions.”
The study authors note that the research took place during the coronavirus pandemic and this could have interrupted the delivery of services across the UK.
The authors said: “Our findings highlight that children from minority ethnic groups represent a population for whom we need to better understand and address inequalities in outcomes.”
One of the limitations of the study acknowledged by the authors was that black children may be less likely to suffer from appendicitis.
Dr. Amaki Sogbodjor, an anesthetist at Great Ormond Street Hospital and University College London and lead author of the study, said: ‘Children with acute appendicitis provide a particularly useful cohort in which to assess the impact of ethnicity on health and healthcare outcomes. due to the similarity of the clinical condition – all children showed the same suspected pathology.
“The ‘free at the point of delivery’ NHS care model should reduce the impact of unequal access to healthcare, which could partly explain the different outcomes in other healthcare systems. However, while access to services may be universally available, the use and delivery of services may still vary.
“A review of healthcare processes is necessary to understand whether the quality of care provided is comparable for everyone.”
Prof. Ramani Moonesinghe, co-author of the study, said: ‘In the UK NHS, a universally accessible healthcare system, ethnicity, but not socio-economic status, was associated with an increased risk of postoperative complications in children undergoing surgery for acute complications. appendicitis. Further assessments and interventions are needed to address these health inequalities, in line with NHS and international priorities.
“The finding that some ethnic minority groups had worse outcomes even after taking into account long-term health problems, factors related to the severity of their acute illness and their socio-economic position, came as a surprise.”
Moonesinghe added: ‘Population-level health inequalities, such as the higher incidence of childhood obesity among black and some Asian minorities, may provide some explanation. Moreover, the Observatory on Race and Health has previously highlighted concerns that low oxygen levels may be more difficult to detect in dark-skinned people using pulse oximetry.
“As the need for oxygen before surgery was another risk factor for postoperative complications, the risk that low oxygen levels are less likely to be recognized in black children should be further investigated.”