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Systematic Review of Disparities in Care and Outcomes in Pediatric Appendectomy
Martha-Conley E Ingram1, Kristen Calabro2, Stephanie Polites3
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Insights
Social, racial, and economic factors negatively impact pediatric appendicitis outcomes. Children from disadvantaged backgrounds experience higher perforation rates and longer hospital stays, highlighting significant surgical care disparities.
Area of Science:
- Pediatric Surgery
- Health Disparities Research
- Socioeconomic Impacts on Health
Background:
- Social, racial, and economic inequities' impact on pediatric health and surgical outcomes is not well-documented.
- Existing literature inadequately describes disparities in surgical care for children.
Purpose of the Study:
- To systematically review and analyze existing literature on disparities in pediatric appendicitis care.
- To identify how social, racial, and economic factors influence surgical outcomes in children with appendicitis.
Main Methods:
- Systematic review of studies on pediatric appendicitis disparities.
- Analysis of nine retrospective studies (1983-2010) involving 350,408 pediatric cases.
- Examined outcomes: length of stay, appendiceal perforation rate, surgical approach, and misdiagnosis rates.
Main Results:
- Appendiceal perforation rates were higher in younger children, rural populations, and those treated at children's hospitals.
- Longer length of stay associated with younger age, African American race, and lower family income.
- Inequities in laparoscopic surgery use, time to surgery, and misdiagnosis linked to age and race.
Conclusions:
- Social, racial, and economic inequalities significantly affect the management and outcomes of pediatric appendicitis.
- Further research is essential to better understand and reduce disparities in surgical care for children.
- Addressing these inequities is crucial for improving pediatric surgical outcomes.
Background:
The impact of social, racial, and economic inequities on health and surgical outcomes for children is poorly described.
Methods:
A systematic review using search terms related to disparities in care of pediatric appendicitis identified 20 titles and narrowed to 11 full texts. Nine retrospective studies were analyzed, representing 350,408 cases treated across the United States from 1983 to 2010. Outcomes included length of stay (LOS), appendiceal perforation rate (AP), laparoscopic versus open approach, and rate of misdiagnosis.
Results:
The most frequently reported outcomes were LOS (six of nine studies) and AP (six of nine studies). AP was higher for young children (48% for <6 versus 25% for >10), those in rural settings (42% versus 26% in urban settings), and patients receiving care at children's hospitals (35% versus 22% at nonchildren's hospitals). Longer LOS was associated with young age in three studies (2-5 d for age <10 y versus 1-3 d for age >11 y), race in four studies (1.5-3 d for African American children versus 1-2 d for other races), and lower family income in two studies (2-4 d versus 1-3 d for highest income). Inequitable use of laparoscopy, time to surgery, and rates of misdiagnosis were also reported to be associated with age and race.
Conclusions:
Although limited, the existing literature suggests that social, racial, and economic inequalities impact management and outcomes in pediatric appendicitis. More studies are needed to better describe and mitigate disparities in the surgical care of children.
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