Impact of Social Determinants and Presence of Congenital Anomalies on Surgical Outcomes in Infants in Texas.

INTRODUCTION

Surgical care of infants is complex and influenced by the presence of congenital anomalies (CAs) and social determinants of health (SDoH), with well-described disparities in Black/Indigenous/people of color (BIPOC) populations. However, the impact of BIPOC on CA and subsequent surgical outcomes is not well-delineated in the literature. We aim to describe the individual and combined impact of CAs and BIPOC on clinical outcomes of surgical care of infants in Texas.

METHODS

A retrospective cohort study using state-wide Hospital Inpatient Discharge Public Use Data File (7/1/2020-6/20/2023) was performed for infants <1 y of age in Texas. CAs were identified based on International Classification of Diseases, Tenth Revision codes. The impact of BIPOC on outcomes and health care utilization in surgical admissions for infants was analyzed. Admissions without race/ethnicity listed and transfers to other facilities were excluded.

RESULTS

Of 1,035,441 infant admissions, 615,045 (59%) were for BIPOC patients. BIPOC admissions were less likely to undergo surgical interventions compared with non-BIPOC (surgical BIPOC 19.1% versus surgical non-BIPOC 25.3%). Surgical BIPOC admissions were more likely to have a diagnosed CA compared with surgical non-BIPOC admissions (surgical BIPOC 24% versus surgical non-BIPOC 20%) despite similar baseline CA incidence (BIPOC 18% versus non-BIPOC 17%). Surgical BIPOC admissions had higher charges ($7378 [IQR:$4981-14,028]) than surgical non-BIPOC admissions ($6720 [interquartile range [IQR]:$4807-11,656]) when treated at non-CSV centers. However, surgical BIPOC admissions had lower charges ($126,488 [IQR:$34,165-410,061]) than surgical non-BIPOC admissions ($161,071 [IQR:$56,649-436,834]) when treated at Children's Surgery Verified (CSV) centers. Moreover, surgical BIPOC admissions had a higher mortality rate (0.5%) compared to surgical non-BIPOC admissions (0.3%) at non-CSV centers. However, surgical BIPOC admissions had a lower mortality rate (2.9%) compared to surgical non-BIPOC (3.4%) when treated at CSV centers. A logistic regression to determine the odds ratio of mortality based on several independent variables determined that BIPOC status significantly increased odds of mortality by 1.192 (95% confidence interval [CI]: 1.10-1.29) (P value: <0.0001).

CONCLUSIONS

Despite similar CA rates between BIPOC and non-BIPOC admissions, BIPOC infants were less likely to have surgical intervention. Surgical BIPOC infants treated at non-CSV centers were more likely to have an associated CA, have a higher illness severity score, accrue higher operative charges, and have a higher mortality rate compared with surgical non-BIPOC infants. However, surgical non-BIPOC infants treated at CSVs were more likely to have an associated CA, have a higher illness severity score, accrue higher operative charges, and have a higher mortality rate compared with surgical BIPOC infants. Nevertheless, BIPOC admissions, whether surgical or nonsurgical, were independently associated with higher mortality.