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Obesity, Race, and Perioperative Complications

  • Pediatric Anesthesia (R Agarwal, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review highlights the perioperative issues pediatric anesthesiologists may encounter while caring for an increasingly obese and racially/ethnically diverse patient population. We provide insight into the scope and impact of both pediatric obesity and pediatric minority status on perioperative management and outcomes and emphasize their points of intersection.

Recent Findings

In recent decades, obesity prevalence in children has steadily increased and the age at onset has declined. Obesity confers significant perioperative risk in pediatric patients and has strong associations with additional comorbidities that impact perioperative patient management. Non-white race/ethnicity is associated with greater rates of obesity, and also carries a significant independent association with perioperative risks, up to and including mortality. Recent data points to non-Hispanic Black and Hispanic patients as being particularly vulnerable.

Summary

As the US pediatric population is becoming more obese, it is also becoming more racially and ethnically diverse. Obesity confers additional perioperative risk to all patients, regardless of race or ethnicity. However, minority race/ethnicity appears to confer additional and independent risk. Therefore, the obese minority patient may be at a particular disadvantage when considering comorbidities and assessing perioperative risks.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Section on Anesthesiology and Pain Medicine, Polaner DM, Houck CS; American Academy of Pediatrics. Critical Elements for the Pediatric Perioperative Anesthesia Environment. Pediatrics. 2015;136(6):1200–5. https://doi.org/10.1542/peds.2015-3595.

  2. Von Ungern-Sternberg BS, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet. 2010;376(9743):773–83. https://doi.org/10.1016/S0140-6736(10)61193-2.

    Article  Google Scholar 

  3. Regli A, Becke K, von Ungern-Sternberg BS. An update on the perioperative management of children with upper respiratory tract infections. Curr Opin Anaesthesiol. 2017;30(3):362–7. https://doi.org/10.1097/ACO.0000000000000460.

    Article  CAS  PubMed  Google Scholar 

  4. J. E. Havidich, M. Beach, S. F. Dierdorf, T. Onega, G. Suresh, and J. P. Cravero, “Preterm versus term children: analysis of sedation/anesthesia adverse events and longitudinal risk,” Pediatrics, vol. 137, no. 3, 2016, https://doi.org/10.1542/peds.2015-0463.

  5. Coté CJ. Anesthesiological considerations for children with obstructive sleep apnea. Curr Opin Anaesthesiol. 2015;28(3):327–32. https://doi.org/10.1097/ACO.0000000000000187.

    Article  CAS  PubMed  Google Scholar 

  6. Tsai A, Schumann R. Morbid obesity and perioperative complications. Curr Opin Anaesthesiol. 2016;29(1):103–8. https://doi.org/10.1097/ACO.0000000000000279.

    Article  CAS  PubMed  Google Scholar 

  7. O. O. Nafiu, K. Owusu-Bediako, M. B. B. Ch, and W. T. Chimbira, “Unequal rates of serious perioperative respiratory adverse events between Black and White children,” https://doi.org/10.1016/j.jnma.2019.03.006.

  8. Ludwig DS. Epidemic childhood obesity: not yet the end of the beginning. Pediatrics. 2018;141(3):e20174078. https://doi.org/10.1542/peds.2017-4078.

    Article  PubMed  Google Scholar 

  9. A. C. Skinner, E. M. Perrin, L. A. Moss, and J. A. Skelton, “Cardiometabolic risks and severity of obesity in children and young adults,” N. Engl. J. Med., 2015, https://doi.org/10.1056/NEJMoa1502821.

  10. “Childhood Obesity Facts | Overweight & Obesity | CDC.” https://www.cdc.gov/obesity/data/childhood.html (accessed Nov. 30, 2020).

  11. C. M. Hales, M. D. Carroll, C. D. Fryar, and C. L. Ogden, “Prevalence of obesity among adults and youth: United States, 2015-2016,” NCHS Data Brief, no. 288, pp. 1–8, 2017, Accessed: Nov. 30, 2020. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/29155689/.

  12. T. Lobstein and H. Brinsden, “Atlas of Childhood Obesity October 2019,” 2019. Accessed: Feb. 07, 2021. [Online]. Available: www.worldobesity.org.

  13. • Geserick M, Vogel M, Gausche R, Lipek T, Spielau U, Keller E, et al. Acceleration of BMI in early childhood and risk of sustained obesity. N Engl J Med. 2018;379(14):1303–12. https://doi.org/10.1056/NEJMoa1803527First study to demonstrate the risk of adolescent obesity manifests by 3-5 years of age.

    Article  PubMed  Google Scholar 

  14. D. S. Ludwig, “Lifespan weighed down by diet,” JAMA - Journal of the American Medical Association, vol. 315, no. 21. American Medical Association, pp. 2269–2270, 2016, https://doi.org/10.1001/jama.2016.3829.

  15. •• Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics. 2018;141(3):e20173459. https://doi.org/10.1542/peds.2017-3459Nationally representative data from 1999–2016 showed no reduction in obesity prevalence for ANY age group among children 2–19 years. Also showed continued racial and ethnic disparities in obesity, especially the most extreme weight categories.

    Article  PubMed  Google Scholar 

  16. Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clin Proc. 2017;92(2) Elsevier Ltd:251–65. https://doi.org/10.1016/j.mayocp.2016.09.017.

    Article  Google Scholar 

  17. Tait AR, Voepel-Lewis T, Burke C, Kostrzewa A, Lewis I. Incidence and risk factors for perioperative adverse respiratory events in cbildren who are obese. Anesthesiology. 2008;108(3):375–80.

    Article  Google Scholar 

  18. O. O. Nafiu, K. S. Ndao-Brumlay, O. A. Bamgbade, M. Morris, and J. Z. Kasa-Vubu, “Prevalence of overweight and obesity in a U.S. pediatric surgical population.,” J Natl Med Assoc., vol. 99, no. 1, pp. 46–8, 50–1, 2007, Accessed: Aug. 29, 2019. [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/17304968.

  19. Bluth T, Pelosi P, De Abreu MG. The obese patient undergoing nonbariatric surgery. Curr Opin Anaesthesiol. 2016;29(3) Lippincott Williams and Wilkins:421–9. https://doi.org/10.1097/ACO.0000000000000337.

    Article  CAS  PubMed  Google Scholar 

  20. Lang LH, Parekh K, Tsui BYK, Maze M. Perioperative management of the obese surgical patient. Br Med Bull. 2017;124(1) Oxford University Press:135–55. https://doi.org/10.1093/bmb/ldx041.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. • “ASA Physical Status Classification System | American Society of Anesthesiologists (ASA).” https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system (accessed Jan. 11, 2021). Now with separate, specific pediatric Physical Status examples.

  22. Nafiu OO, Reynolds PI, Bamgbade OA, Tremper KK, Welch K, Kasa-Vubu JZ. Childhood body mass index and perioperative complications. Paediatr Anaesth. 2007;17(5):426–30. https://doi.org/10.1111/j.1460-9592.2006.02140.x.

    Article  PubMed  Google Scholar 

  23. Hirsch DG, Tyo J, Wrotniak BH. Desaturation in procedural sedation for children with long bone fractures: does weight status matter? Am J Emerg Med. 2017;35(8):1060–3. https://doi.org/10.1016/j.ajem.2017.02.036.

    Article  PubMed  Google Scholar 

  24. Scherrer PD, Mallory MD, Cravero JP, Lowrie L, Hertzog JH, Berkenbosch JW. The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth. 2015;25(7):689–97. https://doi.org/10.1111/pan.12627.

    Article  PubMed  Google Scholar 

  25. Freemark M. Determinants of risk for childhood obesity. N Engl J Med. 2018;379(14):1371–2. https://doi.org/10.1056/NEJMe1811305.

    Article  PubMed  Google Scholar 

  26. FAIR Health Inc, “Obesity and type 2 diabetes as documented in private claims data,” 2017. https://doi.org/10.2337/dc11-s212.4.

  27. Rogers R, Eagle TF, Sheetz A, Woodward A, Leibowitz R, Song MK, et al. The relationship between childhood obesity, low socioeconomic status, and race/ethnicity: lessons from Massachusetts. Child Obes. Dec. 2015;11(6):691–5. https://doi.org/10.1089/chi.2015.0029.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Williams AS, Ge B, Petroski G, Kruse RL, McElroy JA, Koopman RJ. Socioeconomic status and other factors associated with childhood obesity. J Am Board Fam Med. Jul. 2018;31(4):514–21. https://doi.org/10.3122/jabfm.2018.04.170261.

    Article  PubMed  Google Scholar 

  29. Becker G, Newsom E. Socioeconomic status and dissatisfaction with health care among chronically ill African Americans. Am J Public Health. 2003;93(5) American Public Health Association Inc:742–8. https://doi.org/10.2105/AJPH.93.5.742.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Abbasi A, Juszczyk D, van Jaarsveld CHM, Gulliford MC. Body mass index and incident type 1 and type 2 diabetes in children and young adults: A retrospective cohort study. J Endocr Soc. 2017;1(5):524–37. https://doi.org/10.1210/js.2017-00044.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Divers J, et al. Trends in incidence of type 1 and type 2 diabetes among youths — selected counties and Indian reservations, United States, 2002–2015. MMWR Morb Mortal Wkly Rep. 2020;69(6):161–5. https://doi.org/10.15585/mmwr.mm6906a3.

    Article  PubMed  PubMed Central  Google Scholar 

  32. V. Leung and K. Ragbir-Toolsie, “Perioperative management of patients with diabetes,” Health Services Insights, vol. 10. SAGE Publications Ltd, 2017, https://doi.org/10.1177/1178632917735075.

  33. Jackson SL, et al. Hypertension among youths — United States, 2001–2016. MMWR Morb Mortal Wkly Rep. 2018;67(27):758–62. https://doi.org/10.15585/mmwr.mm6727a2.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Stewart M, Scattoloni J, Tazhibi G, Nafiu OO. Association of elevated preoperative blood pressure with preincision hypotension in pediatric surgical patients. Paediatr Anaesth. 2016;26(8):844–51. https://doi.org/10.1111/pan.12945.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rosner B, Cook N, Portman R, Daniels S, Falkner B. Blood pressure differences by ethnic group among United States children and adolescents. Hypertension. 2009;54(3):502–8. https://doi.org/10.1161/HYPERTENSIONAHA.109.134049.

    Article  CAS  PubMed  Google Scholar 

  36. A. R. Tait, S. Malviya, T. Voepel-Lewis, H. M. Munro, M. Siewert, and U. A. Pandit, “Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections,” 2001. Accessed: Feb. 13, 2021. [Online]. Available: www.anesthesiology.org.

  37. F. Sansone, M. Attanasi, S. Di Pillo, and F. Chiarelli, “Asthma and obesity in children.,” Biomedicines, vol. 8, no. 7, 2020, https://doi.org/10.3390/biomedicines8070231.

  38. A. Sanyaolu, C. Okorie, X. Qi, J. Locke, and S. Rehman, “Childhood and adolescent obesity in the United States: a public health concern,” Global Pediatric Health, vol. 6. SAGE Publications Inc., 2019, https://doi.org/10.1177/2333794X19891305.

  39. Belamarich PF, Luder E, Kattan M, Mitchell H, Islam S, Lynn H, et al. Do obese inner-city children with asthma have more symptoms than nonobese children with asthma? Pediatrics. 2000;106(6):1436–41. https://doi.org/10.1542/peds.106.6.1436.

    Article  CAS  PubMed  Google Scholar 

  40. • L. Farhat, G. Vos, A. De, D. S. Lee, and D. Rastogi, “Atopy and pulmonary function among healthy-weight and overweight/obese children with asthma,” Pediatr. Pulmonol., p. ppul.25005, 2020, https://doi.org/10.1002/ppul.25005. This study involved primarily minority children and demonstrated differences in underlying mechanisms for asthma (non atopic/non allergic) in obese minority children.

  41. N. Center for Health Statistics, “Table C-1. Ever having asthma and still having asthma for children under age 18 years, by selected characteristics: United States, 2018,” 2018. Accessed: Jan. 21, 2021. [Online]. Available: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.

  42. Joseph M, Elliott M, Zelicoff A, Qian Z, Trevathan E, Chang JJ. Racial disparity in the association between body mass index and self-reported asthma in children: a population-based study. J Asthma. 2016;53(5):492–7. https://doi.org/10.3109/02770903.2015.1116084.

    Article  PubMed  Google Scholar 

  43. Bin-Hasan S, Katz S, Nugent Z, Nehme J, Lu Z, Khayat A, et al. Prevalence of obstructive sleep apnea among obese toddlers and preschool children. Sleep Breath. 2018;22(2):511–5. https://doi.org/10.1007/s11325-017-1576-4.

    Article  PubMed  Google Scholar 

  44. Auckley D. Perioperative complications in obstructive sleep apnea patients. Curr Sleep Med Rep. 2016;2(2) Springer International Publishing:87–98. https://doi.org/10.1007/s40675-016-0040-5.

    Article  Google Scholar 

  45. Ohn M, Eastwood P, Ungern-Sternberg BS. Preoperative identification of children at high risk of obstructive sleep apnea. Pediatr Anesth. 2020;30(3):221–31. https://doi.org/10.1111/pan.13788.

    Article  Google Scholar 

  46. Narang I, Mathew JL. Childhood obesity and obstructive sleep apnea. J Nutr Metab. 2012;2012. Hindawi Limited:2012–8. https://doi.org/10.1155/2012/134202.

    Article  Google Scholar 

  47. • R. B. Mitchell et al., “Clinical practice guideline: tonsillectomy in children (update),” Otolaryngol - Head Neck Surg (United States), vol. 160, no. 1_suppl, pp. S1–S42, 2019, 10.1177/0194599818801757. Highlights recommendations for polysomnography in obese patients prior to undergoing tonsillectomy.

  48. Mitchell RB, Garetz S, Moore RH, Rosen CL, Marcus CL, Katz ES, et al. The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) study randomized clinical trial. JAMA Otolaryngol - Head Neck Surg. 2015;141(2):130–6. https://doi.org/10.1001/jamaoto.2014.3049.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gleich SJ, Olson MD, Sprung J, Weingarten TN, Schroeder DR, Warner DO, et al. Perioperative outcomes of severely obese children undergoing tonsillectomy. Paediatr Anaesth. 2012;22(12):1171–8. https://doi.org/10.1111/j.1460-9592.2012.03905.x.

    Article  PubMed  PubMed Central  Google Scholar 

  50. R. B. Mitchell et al., “Clinical practice guideline: tonsillectomy in children (update)—executive summary,” Otolaryngol. Neck Surg., vol. 160, no. 2, 2019, https://doi.org/10.1177/0194599818807917.

  51. J. M. Lavin and R. K. Shah, “Postoperative complications in obese children undergoing adenotonsillectomy,” Int. J. Pediatr. Otorhinolaryngol., vol. 79, no. 10, 2015, https://doi.org/10.1016/j.ijporl.2015.07.038.

  52. Brown KA, Laferrière A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology. 2006;105(4):665–9. https://doi.org/10.1097/00000542-200610000-00009.

    Article  PubMed  Google Scholar 

  53. Cote CJ, Posner KL, Domino KB. Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: houston, we have a problem! Anesth Analg. 2014;118(6):1276–83. https://doi.org/10.1213/ANE.0b013e318294fc47.

    Article  PubMed  Google Scholar 

  54. Cravero JP, Agarwal R, Berde C, Birmingham P, Coté CJ, Galinkin J, et al. The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period. Pediatr Anesth. 2019;29(6):547–71. https://doi.org/10.1111/pan.13639.

    Article  Google Scholar 

  55. Harskamp-Van Ginkel MW, et al. Drug dosing and pharmacokinetics in children with obesity a systematic review. JAMA Pediatr. 2015;169(7) American Medical Association:678–85. https://doi.org/10.1001/jamapediatrics.2015.132.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Vaughns JD, Conklin LS, Long Y, Zheng P, Faruque F, Green DJ, et al. Obesity and pediatric drug development. J Clin Pharmacol. 2018;58(5):650–61. https://doi.org/10.1002/jcph.1054.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. O’Brien LM, Sitha S, Baur LA, Waters KA. Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol. 2006;70(9):1555–60. https://doi.org/10.1016/j.ijporl.2006.04.003.

    Article  PubMed  Google Scholar 

  58. • De A, et al. Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea. J Clin Sleep Med. 2017;13(6):805–11. https://doi.org/10.5664/jcsm.6620Obese children undergoing adenotonsillectomy for OSA are at increased risk for residual OSA on the night of surgery.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Rosen CL, Larkin EK, Kirchner HL, Emancipator JL, Bivins SF, Surovec SA, et al. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr. 2003;142(4):383–9. https://doi.org/10.1067/mpd.2003.28.

    Article  PubMed  Google Scholar 

  60. Weinstock TG, Rosen CL, Marcus CL, Garetz S, Mitchell RB, Amin R, et al. Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates. Sleep. 2014;37(2):261–9. https://doi.org/10.5665/sleep.3394.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Thongyam A, Marcus CL, Lockman JL, Cornaglia MA, Caroff A, Gallagher PR, et al. Predictors of perioperative complications in higher risk children after adenotonsillectomy for obstructive sleep apnea: a prospective study. Otolaryngol - Head Neck Surg (United States). 2014;151(6):1046–54. https://doi.org/10.1177/0194599814552059.

    Article  Google Scholar 

  62. R. Wang et al., “Associations among neighborhood, race, and sleep apnea severity in children. A six-city analysis,” Ann. Am. Thorac. Soc., vol. 14, no. 1, 2017, https://doi.org/10.1513/AnnalsATS.201609-662OC.

  63. Ou-Yang MC, Sun Y, Liebowitz M, Chen CC, Fang ML, Dai W, et al. Accelerated weight gain, prematurity, and the risk of childhood obesity: a meta-analysis and systematic review. PLoS One. 2020;15(5) Public Library of Science:e0232238. https://doi.org/10.1371/journal.pone.0232238.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Sadras I, Reiter J, Fuchs N, Erlichman I, Gozal D, Gileles-Hillel A. Prematurity as a risk factor of sleep-disordered breathing in children younger than two years: a retrospective case-control study. J Clin Sleep Med. 2019;15(12):1731–6. https://doi.org/10.5664/jcsm.8072.

    Article  PubMed  PubMed Central  Google Scholar 

  65. “Preterm by race/ethnicity United States | PeriStats | March Of Dimes.” https://www.marchofdimes.org/Peristats/ViewSubtopic.aspx?reg=99&top=3&stop=63&lev=1&slev=1&obj=1.

  66. Raphael JL, Beal AC. A review of the evidence for disparities in child vs adult health care: a disparity in disparities. J Natl Med Assoc. 2010;102(8):684–91. https://doi.org/10.1016/S0027-9684(15)30653-2.

    Article  PubMed  Google Scholar 

  67. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077) Lancet Publishing Group:1453–63. https://doi.org/10.1016/S0140-6736(17)30569-X.

    Article  PubMed  Google Scholar 

  68. K. Peterson, J. Anderson, E. Boundy, L. Ferguson, E. McCleery, and K. Waldrip, “Mortality disparities in racial/ethnic minority groups in the Veterans Health Administration: an evidence review and map,” Am. J. Public Health, vol. 108, no. 3, 2018, https://doi.org/10.2105/AJPH.2017.304246.

  69. Baetzel AE, Holman A, Dobija N, Reynolds PI, Nafiu OO. Racial disparities in pediatric anesthesia. Anesthesiol Clin. 2020;38(2) W.B. Saunders:327–39. https://doi.org/10.1016/j.anclin.2020.01.010.

    Article  PubMed  Google Scholar 

  70. • O. O. Nafiu, K. Owusu-Bediako, and W. T. Chimbira, “Unequal rates of serious perioperative respiratory adverse events between Black and White children,” J. Natl. Med. Assoc., vol. 111, no. 5, 2019, https://doi.org/10.1016/j.jnma.2019.03.006. Single institution retrospective study of 18,538 Black and white children undergoing various non-otolaryngologic procedures between 2007 and 2014 showing that serious PRAE occurred in 9.6% of Black children and 6.6% of white children (OR 1.7; 95%CI 1.11–2.62).

  71. • B. L. Willer, C. Mpody, J. D. Tobias, and O. O. Nafiu, “Racial disparities in failure to rescue following unplanned reoperation in pediatric surgery,” Anesth. Analg., 2020, https://doi.org/10.1213/ANE.0000000000005329. NSQIP-P retrospective query of 276,917 Black and white children undergoing inpatient surgery between 2012–2017 who experienced a complication necessitating unplanned return to the operating room within 30 days of the index surgery. Black children were twice as likely to experience FTR than their white counterparts (aOR: 2.03; 95%CI 1.5–2.74).

  72. •• O. O. Nafiu, C. Mpody, S. S. Kim, J. C. Uffman, and J. D. Tobias, “Race, postoperative complications, and death in apparently healthy children,” Pediatrics, vol. 146, no. 2, 2020, https://doi.org/10.1542/peds.2019-4113. Retrospective NSQIP-P study of 172,549 Black and white children undergoing inpatient surgery between 2012 and 2017 with ASA physical status assignment of 1 or 2. Black children were nearly 3.5 times as likely to die within 30 days of surgery than white children (OR: 3.43; 95%CI 1.73–6.79). Black children were also more likely to develop postoperative complications (OR: 1.18; 95%CI 1.13–1.23) and experience serious adverse events (OR: 1.07; 95%CI 1.01–1.14).

  73. • Costello JM, et al. Associations between unplanned cardiac reinterventions and outcomes after pediatric cardiac operations. Ann Thorac Surg. 2018;105(4):1255–63. https://doi.org/10.1016/j.athoracsur.2017.10.05084,404 children undergoing congenital heart surgery included in the STSCHSD from 2010 to 2015 were evaluated for risks leading to unplanned cardiac reintervention (operative or therapeutic catheterization). Nonwhite race was found to be an independent risk factor for unplanned reintervention (aOR 1.28; 95%CI 1.17–1.39 for Black v white race) (aOR 1.15; 95%CI 1.07–1.24 for nonwhite nonblack v white race). Furthermore, unplanned cardiac reintervention was found to be an independent risk factor for operative mortality (aOR 5.3; 95%CI 4.8-5.8).

    Article  PubMed  Google Scholar 

  74. T. Chan, K. C. Lion, and R. Mangione-Smith, “Racial disparities in failure-to-rescue among children undergoing congenital heart surgery,” J. Pediatr., vol. 166, no. 4, 2015, https://doi.org/10.1016/j.jpeds.2014.11.020.

  75. J. H. Silber, S. V. Williams, H. Krakauer, and S. Schwartz, “Hospital and patient characteristics associated with death after surgery,” Med. Care, vol. 30, no. 7, 1992, https://doi.org/10.1097/00005650-199207000-00004.

  76. J. H. Silber, P. S. Romano, A. K. Rosen, Y. Wang, O. Even-Shoshan, and K. G. Volpp, “Failure-to-Rescue,” Med. Care, vol. 45, no. 10, 2007, https://doi.org/10.1097/MLR.0b013e31812e01cc.

  77. E. F. Boss, D. F. Smith, and S. L. Ishman, “Racial/ethnic and socioeconomic disparities in the diagnosis and treatment of sleep-disordered breathing in children,” Int. J. Pediatr. Otorhinolaryngol., vol. 75, no. 3, 2011, https://doi.org/10.1016/j.ijporl.2010.11.006.

  78. Kou Y, Sakai M, Shah GB, Mitchell RB, Johnson RF. Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: a cross-sectional study. Laryngoscope. 2019;129(4):995–1000. https://doi.org/10.1002/lary.27405.

    Article  PubMed  Google Scholar 

  79. P. P. Pecha et al., “Racial disparities in pediatric endoscopic sinus surgery,” Laryngoscope, Sep. 2020, https://doi.org/10.1002/lary.29047.

  80. A. Vedantam, I.-W. Pan, K. A. Staggers, and S. K. Lam, “Thirty-day outcomes in pediatric epilepsy surgery,” Child’s Nerv. Syst., vol. 34, no. 3, 2018, https://doi.org/10.1007/s00381-017-3639-z.

  81. E. M. Pestana Knight, N. K. Schiltz, P. M. Bakaki, S. M. Koroukian, S. D. Lhatoo, and K. Kaiboriboon, “Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009,” Epilepsia, vol. 56, no. 3, 2015, https://doi.org/10.1111/epi.12912.

  82. G. Livingston, “The rise of multiracial and multiethnic babies in the U.S.,” Pew Research Center, 2017. http://pewrsr.ch/2rI8Zth (accessed Jan. 01, 2021).

  83. •• K. Parker, J. Menasce Horowitz, R. Morin, and M. Hugo Lopez, “Multiracial in America,” Pew Research Center, 2015. https://www.pewsocialtrends.org/2015/06/11/multiracial-in-america/#fn-20523-3 (accessed Jan. 01, 2021). Pew Research Center resource extensively discusses the increasing multiracial population in America and their unique social experiences which contribute to their ideology and identity within the community.

  84. “Less than half of US children under 15 are white, census shows.” https://www.brookings.edu/research/less-than-half-of-us-children-under-15-are-white-census-shows/ (accessed Nov. 30, 2020).

  85. D. I. Chu, D. A. Canning, and G. E. Tasian, “Race and 30-day morbidity in pediatric urologic surgery,” Pediatrics, vol. 138, no. 1, 2016, https://doi.org/10.1542/peds.2015-4574, e20154574.

  86. O. Akbilgic, M. R. Langham, and R. L. Davis, “Race, preoperative risk factors, and death after surgery,” Pediatrics, vol. 141, no. 2, 2018, https://doi.org/10.1542/peds.2017-2221.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 604, Rochester, NY, 14642, USA

    Audra M. Webber

  2. Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Brittany L. Willer

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  1. Audra M. Webber
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Correspondence to Audra M. Webber.

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Webber, A.M., Willer, B.L. Obesity, Race, and Perioperative Complications. Curr Anesthesiol Rep 11, 248–256 (2021). https://doi.org/10.1007/s40140-021-00458-1

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