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Determinants of appendicitis outcomes in Canadian children
Li Hsia Alicia Cheong1, Sherif Emil1
1Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre.
Insights
In Canada, pediatric appendicitis outcomes are linked to where a child is treated and the type of care they receive. Factors like age, gender, and surgeon specialty influence misdiagnosis and perforation rates.
Area of Science:
- Pediatric Surgery
- Healthcare Access and Outcomes
- Public Health
Background:
- Appendicitis outcomes can be affected by healthcare access.
- This study examines pediatric appendicitis outcomes within Canada's single-payer system.
Purpose of the Study:
- To investigate the determinants of pediatric appendicitis outcomes.
- To analyze factors influencing misdiagnosis, perforation, and hospital stay in pediatric appendicitis.
Main Methods:
- Analysis of 41,702 children undergoing urgent appendectomy (2004-2010) from Canadian Institute of Health Information data.
- Logistic regression and quintile regression models were used to assess associations with outcomes.
- Variables included age, gender, socioeconomic status, surgeon specialty, hospital type, region, and operative approach.
Main Results:
- Lower age, male gender, pediatric surgeon, and treatment outside the Maritimes were associated with higher perforated appendicitis rates.
- Higher misdiagnosis rates were linked to younger age, female gender, non-children's hospitals, and western Canada.
- Longer hospital stays correlated with open appendectomy, pediatric surgeons, and specific regions/hospital types depending on appendicitis severity.
Conclusions:
- Pediatric appendicitis outcomes in Canada are influenced by regional and treatment-specific factors.
- Rural domicile and socioeconomic status were not found to significantly impact outcomes.
Background:
Outcomes of appendicitis may be influenced by access to healthcare. We investigated the determinants of pediatric appendicitis outcomes in the single-payer Canadian healthcare system.
Methods:
Children coded for urgent appendectomy by the Canadian Institute of Health Information during the period 2004-2010 were analyzed. Misdiagnosis rate, perforated appendicitis rate, and hospital stay were the outcomes studied. Analyzed variables included age, gender, domicile, socioeconomic status, surgeon's specialty, hospital type, region, and operative approach. Logistic regression analysis was used to examine associations, and a quintile regression model examined the effect on median hospital stay.
Results:
41,702 patients were studied. A higher rate of perforated appendicitis was associated with lower age [OR 2.66], male gender [OR 1.18], pediatric surgeon [OR 1.25], and treatment outside the Maritimes. A higher rate of misdiagnosis was associated with lower age [OR 1.53], female gender [OR 2.29], non-children's hospital [OR 1.33], and western Canada [OR 1.22]. A significantly longer hospital stay was associated with open appendectomy, pediatric surgeon, and the Territories for simple appendicitis, and open appendectomy, pediatric surgeon, children's hospital, and the Maritimes for perforated appendicitis.
Conclusions:
In Canada, outcomes of pediatric appendicitis are associated with regional and treatment-level factors. Rural domicile and socioeconomic status do not affect outcomes.
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