Related Experiment Videos
Acute appendicitis risks of complications: age and Medicaid insurance
S L Bratton1, C M Haberkern, J H Waldhausen
1Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA. bratton@ohsu.edu
Insights
Young children and those with Medicaid insurance face higher risks of complicated appendicitis. This study highlights disparities in pediatric acute appendicitis outcomes.
Area of Science:
- Pediatric Surgery
- Epidemiology
- Health Services Research
Background:
- Acute appendicitis is a common surgical emergency in children.
- Understanding risk factors for complicated appendicitis is crucial for improving outcomes.
Purpose of the Study:
- To describe the epidemiology of acute appendicitis in children in Washington State.
- To identify risk factors associated with complicated appendicitis in pediatric patients.
Main Methods:
- Retrospective cohort study utilizing hospital discharge data from Washington State (1987-1996).
- Inclusion criteria: children (<17 years) with a primary diagnosis code for acute appendicitis.
- Complicated disease defined as perforation or abscess formation.
Main Results:
- Young children (0-4 years) had the lowest incidence but a 5-fold increased risk of complicated appendicitis compared to teenagers.
- Children with Medicaid insurance had a 1.3-fold increased risk of complicated disease versus those with commercial insurance.
- Medicaid patients experienced a longer average hospital stay.
Conclusions:
- Very young children and those with Medicaid insurance are at higher risk for complicated appendicitis.
- Disparities in care and outcomes associated with insurance type warrant further investigation.
- Additional research is needed to address barriers to care for children with Medicaid insurance.
Objectives:
To describe the epidemiology of acute appendicitis in children from Washington State, and to determine important risk factors for complications.
Design:
Retrospective cohort study.
Setting:
All children (<17 years old) treated in Washington State who were identified by hospital discharge diagnosis codes from 1987 through 1996.
Methods:
The hospital discharge data were reviewed for all children with a primary diagnosis code for acute appendicitis. Complicated disease was defined as perforation or abscess formation.
Results:
Young children (0-4 years old) had the lowest annual incidence of acute appendicitis, but they had a 5-fold increased risk of complicated disease (odds ratio: 4.9; 95% confidence interval: 4.0-5.9), compared with teenagers. Children with Medicaid insurance had a 1.3-fold increased risk of complicated disease, compared with children with commercial insurance (odds ratio: 1.3: 95% confidence interval: 1.2-1.4). Children with Medicaid insurance had significantly longer average length of stay (4.0+/-3.7 days) than all other payers (commercial insurance: 3.3+/-4.0 days; health maintenance organization: 3.5+/-3.1 days; and self-insured: 3.7+/-5.8 days).
Conclusions:
Very young children had the greatest risk of complicated disease. Children with Medicaid insurance had increased risk of complicated disease, compared with children with commercial health insurance and longer length of stay. Additional studies are needed to evaluate barriers to care for children with Medicaid insurance.