Perioperative pain disparity in children: A call for action

Abstract

Over the past several decades, the proportion of children in non-White racial and ethnic groups in the United States has increased significantly. For example, the Latinx population is currently the country's second largest racial/ethnic group and is expected to increase from 62 million persons to an estimated 111 million by 2060.The terms "Hispanic" and "Latinx" are often used interchangeably, but Hispanic refers to those who speak Spanish or are descended from a Spanish-speaking lineage, whereas Latinx refers to those of Latin American origin or descent (used as a gender-neutral alternative to Latino or Latina). Latinx children also comprise 25.6% of US children under the age of 16, or an estimated 19 million children.Additionally, Black children comprise 14% of US children, and the proportion of multiracial children in the US has tripled in the past decade from 5% to 15%.Racial disparities in healthcare outcomes and delivery have been extensively documented across multiple areas of medicine, including surgical domains. Racial and ethnic minorities have been shown to not only have worse clinical outcomes after surgery, but to also have lower rates of surgical procedures compared with non-minorities even after adjusting for insurance status. 1 Despite the fact that national initiatives aimed at reducing racial disparities in health care were first implemented in 2011, these surgical disparities continue to exist today. 1 Indeed, a recent NIH-ACS Symposium on Surgical Disparities Research has identified an urgent need for research aimed at understanding and addressing these disparities. Surgical disparities in adult patients have been long-established, and there is also significant evidence to indicate that minority children experience markedly higher rates of postoperative mortality and complications. 2 In the past, these disparities were commonly attributed to a higher comorbidity burden in minority populations 3 ; however, it was found that even among apparently healthy children, outcomes still varied significantly with race. Across 186 medical centers in the US, Black children experienced a 3.5 times increased risk of dying within 30 days of surgery compared with White children. 2 Furthermore, despite neither group having significant preoperative comorbidities, Black children had a 27% higher risk of postoperative complications and serious adverse events, including sepsis, bleeding that required transfusion, unplanned reoperation, and unplanned tracheal reintubation. 2

The intersection of pediatric anesthesiology and social determinants of health

“…Of note, this review will present research that goes beyond examining racial disparities (i.e., differences in perioperative outcomes across racial or ethnic groups) and incorporates the measurement of SDOH variables and analyzes the effect of SDOH on perioperative outcomes. For an update on racial disparities in pediatric anesthesia, please see recent reviews by Willer et al [2 ] and Tan et al [1] for a comprehensive overview of racial disparities in pediatric anesthesia and perioperative pain management.…”

“…There is a growing body of literature documenting pediatric perioperative care disparities and treatment inequities [1,2 ▪ ], which underscores the need to identify and address factors driving disparities in pediatric perioperative care. To date, evidence of pediatric perioperative disparities has primarily come from research comparing perioperative outcomes across racial and ethnic groups, with data indicating that children of racial and ethnic minoritized groups are more likely to experience inequitable care and poorer outcomes, including more postoperative complications, longer lengths of stay, and inadequate perioperative pain management [1,2 ▪ ]. To identify treatment practices that promote more equitable care and outcomes, it is imperative to appreciate and identify multidimensional, systemic, and social mechanisms driving these disparities.…”

Barriers and facilitators to using procedural pain treatments in pediatric patients: protocol for a systematic review and meta-synthesis

“…Synthesizing the existing barriers and facilitators to using procedural pain treatments in pediatric patients is the premise of developing effective strategies. (37)(38)(39). Therefore, this systematic review will synthesize barriers and facilitators in the literature under the guidance of implementation science and evaluate the importance of different factors (37).…”