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Differences in the Management of Perforated Appendicitis in Children by Race and Insurance Status

Randi L Lassiter, Robyn M Hatley

    The American Surgeon
    |September 30, 2017
    PubMed

    Insights

    Racial and socioeconomic factors significantly impact pediatric perforated appendicitis treatment. Black children and self-pay patients received less surgical intervention, highlighting disparities in care.

    Area of Science:

    • Pediatric Surgery
    • Health Disparities Research
    • Health Services Research

    Background:

    • Perforated appendicitis in children requires timely and appropriate management.
    • Previous research suggests disparities in appendicitis outcomes are linked to perforation rates and healthcare access.
    • Understanding treatment variations based on patient demographics is crucial for equitable care.

    Purpose of the Study:

    • To investigate the influence of race and socioeconomic status on the management of pediatric perforated appendicitis.
    • To analyze associations between patient characteristics and surgical versus non-surgical treatment approaches.

    Main Methods:

    • Analysis of a large national inpatient dataset (2001-2010) for pediatric appendicitis admissions.
    • Inclusion of nonelective admissions with a primary diagnosis of perforated appendicitis.
    • Bivariate and multivariate analyses to assess associations between race, insurance, income, location, and treatment modality (surgery, percutaneous drainage, or neither).

    Main Results:

    • Surgery was performed in 90.5% of 46,211 identified cases.
    • Black children had lower odds of surgery (AOR=0.53) and higher odds of non-surgical percutaneous drainage (AOR=1.79).
    • Self-pay patients showed reduced odds of laparoscopic surgery (AOR=0.80), while rural children had higher odds of surgery (AOR=1.30).

    Conclusions:

    • Significant racial and socioeconomic disparities exist in the management strategies for pediatric perforated appendicitis.
    • Dissimilar treatment approaches are evident even when patients present with the same diagnosis.
    • These findings underscore the need to address inequities in pediatric surgical care.

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