Children of color are less likely to undergo elective surgery. What does this mean?

Latino, Black and Asian children are less likely to undergo elective surgeries compared with white children, according to a recent study.

The study, published in the Journal of Pediatric Surgery, analyzed data on more than 200,000 children from a national health survey of parents. Roughly 10,000 of those children reportedly had surgery.

Between 40% and 60% fewer surgeries were reported by parents of Black, Asian and Latino children, and Latino children were more likely to have emergency surgery.

The research shows children of color could be suffering amid delays in important surgical interventions, experts say.

Further investigation is needed and experts aren’t certain of the cause of the differences. But the findings add to growing evidence of surgical disparities in children of color and underscore inequities in children’s health as the nation continues to reckon with structural racism in health care systems, experts say.

“There’s this possible deficit that kids aren’t getting the best surgical treatment for medical issues,” said lead author Dr. Ethan Sanford, a pediatric anesthesiologist at the University of Texas Southwestern Medical Center.

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What pediatric surgical disparities were found?

Compared with their white counterparts, Black and Latino children were about 40% less likely and Asian children about 60% less likely to report having had surgery.

Systemic factors may be at play, Sanford explained, such as lack of reliable transportation, inflexibility in parents’ work hours and language barriers. Sanford said there’s little to no data that suggests children of color “need less surgery.”

Parents need time off to take their kids to surgery, and often, doctor’s appointments and consultations leading up to the procedure require several appointments.

Even when adjusting for socioeconomic factors like poverty, children of color were still less likely to undergo surgery, according to the findings.

Sanford and his team analyzed data from the National Health Interview Survey and the National Surgical Quality Improvement Program.

What types of pediatric surgeries were reported?

The researchers looked at elective surgeries, which can be scheduled in advance because they aren’t considered emergencies. These can be minor procedures such as removing a mole, or more serious procedures such as tonsillectomies or placement of ear tubes to prevent repeated ear infections.

Delaying an elective surgery can hinder a patient’s quality of life. For example, a child may need a tonsillectomy to relieve sleep apnea, which causes breathing trouble during sleep, Sanford explained.

“Rather than having that procedure done early before, they're having a lot of the negative side effects of chronic sleep apnea,” he said, such as poor sleep and energy and weight gain.

Pediatric surgeon Dr. Adam Alder, American Academy of Pediatrics' Surgical Section chief and a study co-author, also emphasized the importance of timely care.

"Delays in elective surgical care, or the inability to access for families that elective care or that scheduled surgical care, can be life-changing. It can be health-defining," he said. "You (may) have an illness that we've been keeping track of for a period of time and now you're at a point where we can no longer simply observe that."

Dr. Olubukola O. Nafiu, an anesthesiologist at Nationwide Children’s Hospital, cautioned that the findings don’t mean children are being denied surgery.

“We need more studies to try to tease out what’s going on ... to continue to shine the light on these health disparities, which didn’t just start yesterday," he said. "It starts with hundreds of years of history.”

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What is already known about surgical disparities in children?

The findings align with previous studies that show glaring disparities, said Dr. Bridgette Jones, a pediatrician at Children’s Mercy Hospital in Kansas City, Missouri.

For example, Black and Hispanic children have been shown to be less likely to receive adequate pain treatment for appendicitis or fractures compared to white children, she noted. White children coming to the emergency room with minor blunt head trauma or headaches are also more likely to receive head imaging.

These "demonstrate that medical care provided to children is not equitable and that race and ethnicity is a driving factor," she said.

A look at other studies:

Death rates: Among healthy children who had surgery, Black children were three times more likely to die within 30 days after surgery compared to white children, according to a 2020 study led by Nafiu published in the medical journal Pediatrics.

Sleep apnea: Another study found that compared to white children, Black and Hispanic children on Medicaid had higher rates of no surgical interventions for sleep apnea. There is limited data but researchers estimate sleep apnea affects between 7% and 11% of children in the U.S.

Appendicitis: Black children with appendicitis were more likely to have delayed surgery and to suffer a perforated, or ruptured, appendix, a complication when it is left untreated, according to an analysis published in Academic Emergency Medicine.

Reach Nada Hassanein at or on Twitter @nhassanein_.

This article originally appeared on USA TODAY: Pediatric surgery is less common for children of color, study finds