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Evaluation of race and insurance status as predictors of undergoing laparoscopic appendectomy in children
Benjamin A Hagendorf1, Jason G Liao, Mitchell R Price
1Department of Surgery, Division of Pediatric Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Insights
Racial and socioeconomic disparities exist in pediatric appendectomy methods. Laparoscopic appendectomies were more common in white children and those with private insurance, especially at non-children's hospitals.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Socioeconomic Disparities in Healthcare
Background:
- Previous research indicates racial and insurance-related disparities in adult appendicitis management.
- It remains unclear if similar disparities are present in pediatric appendicitis care.
Purpose of the Study:
- To investigate the relationship between race, socioeconomic factors, and the surgical approach (open vs. laparoscopic) for pediatric appendectomies.
- To identify potential disparities in access to minimally invasive surgical techniques for children.
Main Methods:
- Analysis of Nationwide Inpatient Sample data for children (<15 years) undergoing appendectomy (1996-2002).
- Appendicitis severity and comorbidities determined by ICD-9 codes.
- Logistic regression analyses, including risk adjustment, were performed considering hospital characteristics.
Main Results:
- Of 72,189 pediatric appendectomies, 16% were laparoscopic.
- White children had higher odds of laparoscopic appendectomy compared to Black children (OR, 1.14; P=0.01).
- A significant interaction showed private insurance increased laparoscopic appendectomy odds at non-children's hospitals, but not at children's hospitals.
Conclusions:
- Significant racial and insurance-related disparities in laparoscopic appendectomy use among children were identified.
- These disparities were most pronounced at non-children's hospitals.
- Findings suggest that children's hospitals may facilitate better access to advanced surgical technologies.
Objective:
The objective of this study was to determine the relationship of race and socioeconomic factors and the method used for appendectomies in children (open vs. laparoscopic).
Summary Background Data:
Previous studies have shown racial and insurance-related differences associated with the management of appendicitis in adults. It is not known whether these differences are observed in children.
Methods:
Children (<15 years) undergoing appendectomy from 1996 to 2002 were identified in the Nationwide Inpatient Sample. Severity of appendicitis and underlying chronic illnesses were determined by ICD-9 codes. Hospital characteristics evaluated included teaching status and location, children's hospital status, and volume of appendectomies. Hierarchical unadjusted and risk-adjusted logistic regression analyses were performed.
Results:
Among 72,189 children undergoing an appendectomy for appendicitis, 11,714 (16%) underwent a laparoscopic appendectomy. Multivariate analysis showed that whites were more likely to undergo a laparoscopic appendectomy than blacks (odds ratio, 1.14; 95% CI, 1.03-1.25, P = 0.01) but not other races. A significant interaction between payer source and children's hospital designation was observed, with the odds of children with private insurance undergoing laparoscopic appendectomy being significantly higher than those without private insurance at nonchildren's hospitals but not at children's hospitals.
Conclusions:
There are significant racial and insurance-related differences in use of laparoscopic appendectomy in children that are most evident at nonchildren's hospitals. These findings provide evidence that factors at hospitals dedicated to children may lead to better access to new technologies.
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