Skip to main content
Springer Nature Link
Log in

Is Race Associated With Morbidity and Mortality After Hospital Discharge Among Neonates Undergoing Heart Surgery?

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

This study aimed to characterize the impact of race on morbidity and mortality after hospital discharge from neonatal congenital heart surgery. A retrospective chart review examined all the neonates who underwent neonatal heart surgery from January 2005 to June 2006 at The Children’s Hospital of Philadelphia. After risk adjustment for the type of surgery using the Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) method, the association of race with mortality after hospital discharge was assessed using Fisher’s exact test for statistical analysis. A cross-sectional telephone survey of surviving patients also was conducted to examine the association of race and social factors with adverse events (admissions or reinterventions). Mortality status was known for 201 of the 217 patients screened. The mortality rate after discharge was 8 %, with a higher mortality rate for nonwhite patients (14 %) than for white patients (4 %) (p = 0.01). After risk adjustment, this effect was limited to nonwhite patients with less complex heart disease (RACHS-1 categories 1–3; 17 vs 2 %, respectively; p = 0.01). The survey completion rate was 54 %. In this cohort, race also was independently associated with adverse events among patients with less complex heart disease (RACHS-1 categories 1–3; nonwhites 53 % vs whites 25 %; p = 0.046). Among the patients with less complex heart disease, the nonwhite patients had a significantly higher risk of morbidity and mortality after hospital discharge than the white patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Almond CS, Thiagarajan RR, Piercey GE et al (2009) Waiting list mortality among children listed for heart transplantation in the United States. Circulation 119:717–727

    Article  PubMed  Google Scholar 

  2. Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL (2004) Primary care physicians who treat blacks and whites. N Engl J Med 351:575–584

    Article  PubMed  CAS  Google Scholar 

  3. Benavidez OJ, Gauvreau K, Del Nido P, Bacha E, Jenkins KJ (2007) Complications and risk factors for mortality during congenital heart surgery admissions. Ann Thorac Surg 84:147–155

    Article  PubMed  Google Scholar 

  4. Boneva RS, Botto LD, Moore CA, Yang QH, Correa A, Erickson JD (2001) Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 103:2376–2381

    Article  PubMed  CAS  Google Scholar 

  5. Carr W, Zeitel L, Weiss K (1992) Variations in asthma hospitalizations and deaths in New York City. Am J Public Health 82:59–65

    Article  PubMed  CAS  Google Scholar 

  6. Chang RKR, Rodriguez S, Lee M, Klitzner TS (2006) Risk factors for deaths occurring within 30 days and 1 year after hospital discharge for cardiac surgery among pediatric patients. Am Heart J 152:386–393

    Article  PubMed  Google Scholar 

  7. Chavers BM, Snyder JJ, Skeans MA, Weinhandl ED, Kasiske BL (2009) Racial disparity trends for graft failure in the U.S. pediatric kidney transplant population, 1980–2004. Am J Transplant 9:543–549

    Article  PubMed  CAS  Google Scholar 

  8. Committee on Quality of Health Care in America IoM (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DC

    Google Scholar 

  9. Cooper R, Cutler J, Desvigne-Nickens P et al (2000) Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the National Conference on Cardiovascular Disease Prevention. Circulation 102:3137–3147

    Article  PubMed  CAS  Google Scholar 

  10. Demone JA, Gonzalez PC, Gauvreau K, Piercey GE, Jenkins KJ (2003) Risk of death for medicaid recipients undergoing congenital heart surgery. Pediatr Cardiol 24:97–102

    Article  PubMed  CAS  Google Scholar 

  11. Dorfman AT, Marino BS, Wernovsky G et al (2008) Critical heart disease in the neonate: presentation and outcome at a tertiary care center. Pediatr Crit Care Med 9:193–202

    Article  PubMed  Google Scholar 

  12. Doty M (2003) Hispanic patients’ double burden: lack of health insurance and limited English. Commonwealth Fund, New York

  13. Gonzalez PC, Gauvreau K, Demone JA, Piercey GE, Jenkins KJ (2003) Regional racial and ethnic differences in mortality for congenital heart surgery in children may reflect unequal access to care. Pediatr Cardiol 24:103–108

    Article  PubMed  CAS  Google Scholar 

  14. Hehir DA, Dominguez TE, Ballweg JA et al (2008) Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 136:94–99

    Article  PubMed  Google Scholar 

  15. Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900

    Article  PubMed  Google Scholar 

  16. Hoffman JI, Kaplan S, Liberthson RR (2004) Prevalence of congenital heart disease. Am Heart J 147:425–439

    Article  PubMed  Google Scholar 

  17. James CV, Rosenbaum S (2009) Paying for quality care: implications for racial and ethnic health disparities in pediatric asthma. Pediatrics 123:S205–S210

    Article  PubMed  Google Scholar 

  18. Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP (2009) Ewing sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1,631 cases from the SEER database, 1973–2005. Cancer 115:3526–3536

    Article  PubMed  Google Scholar 

  19. Jenkins KJ, Gauvreau K (2002) Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. J Thorac Cardiovasc Surg 124:97–104

    Article  PubMed  Google Scholar 

  20. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118

    Article  PubMed  Google Scholar 

  21. Keenan HT, Foster CM, Bratton SL (2002) Social factors associated with prolonged hospitalization among diabetic children. Pediatrics 109:40–44

    Article  PubMed  Google Scholar 

  22. Lillie-Blanton M, Maddox T, Rushing O (2002) Racial/ethnic differences in cardiac care: the weight of the evidence. The Henry J, Kaiser Family Foundation, Menlo Park

    Google Scholar 

  23. Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC (2004) Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg 78:1972–1978

    Article  PubMed  Google Scholar 

  24. Nembhard WN, Salemi JL, Ethen MK, Fixler DE, DiMaggio A, Canfield MA (2011) Racial/ethnic disparities in risk of early childhood mortality among children with congenital heart defects. Pediatrics 127:e1128–e1138

    Article  PubMed  Google Scholar 

  25. Oster ME, Strickland MJ, Mahle WT (2011) Racial and ethnic disparities in postoperative mortality following congenital heart surgery. J Pediatr 159(2):222–226

    Article  PubMed  Google Scholar 

  26. Patel ND, Weiss ES, Allen JG et al (2009) Heart transplantation for adults with congenital heart disease: analysis of the United network for organ sharing database. Ann Thorac Surg 88:814–821

    Article  PubMed  Google Scholar 

  27. Pinto NM, Lasa J, Dominguez TE et al (2011) Regionalization in neonatal congenital heart surgery: the impact of distance on outcome after discharge. Pediatr Cardiol 33(2):229–238

    Article  PubMed  Google Scholar 

  28. Russo CA, Andrews RM, Barrett M (2006) Racial and ethnic disparities in hospital patient safety events, 2005: Statistical Brief #53. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, 2006 Feb–2008 Jun. Agency for Health Care Policy and Research (US), Rockville, MD

  29. Slover J, Gibson J, Tosteson T, Smith B, Koval K (2005) Racial and economic disparity and the treatment of pediatric fractures. J Pediatr Orthop 25:717–721

    Article  PubMed  Google Scholar 

  30. US Department of Health and Human Services (2000) Healthy People 2010. US Department of Health and Human Services, Washington, DC. www.health.gov/healthypeople/

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, The Children’s Hospital of Philadelphia, 8NW-37, Main Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Javier J. Lasa, Meryl S. Cohen, Gil Wernovsky & Nelangi M. Pinto

  2. School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Javier J. Lasa, Meryl S. Cohen, Gil Wernovsky & Nelangi M. Pinto

Authors
  1. Javier J. Lasa
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Meryl S. Cohen
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Gil Wernovsky
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Nelangi M. Pinto
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Javier J. Lasa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lasa, J.J., Cohen, M.S., Wernovsky, G. et al. Is Race Associated With Morbidity and Mortality After Hospital Discharge Among Neonates Undergoing Heart Surgery?. Pediatr Cardiol 34, 415–423 (2013). https://doi.org/10.1007/s00246-012-0475-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-012-0475-5

Keywords