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Income-Based Disparities in Outcomes Following Pediatric Appendectomy: A National Analysis
Konmal Ali1, Amulya Vadlakonda1, Sara Sakowitz1
1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Insights
Children with lower incomes have a higher risk of complications after appendectomy. Addressing these socioeconomic disparities is crucial for improving pediatric surgical outcomes.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Socioeconomic Disparities
Background:
- Appendectomy is a frequent pediatric surgical procedure, with approximately 80,000 performed annually.
- Previous research highlighted racial disparities in surgical outcomes.
- This study investigates income-based inequalities in pediatric appendectomy outcomes.
Purpose of the Study:
- To analyze the association between patient income level and postoperative outcomes following pediatric appendectomy.
- To identify potential socioeconomic disparities in a national cohort of pediatric appendectomy patients.
Main Methods:
- Utilized data from the 2016-2020 National Inpatient Sample for non-elective pediatric appendectomies.
- Compared patients in the highest income (HI) and lowest income (LI) quartiles.
- Employed multivariable regression to assess the link between income and major adverse events (MAE).
Main Results:
- The LI cohort (58.0%) was younger, more likely to have Medicaid, and of Hispanic ethnicity compared to the HI cohort (42.0%).
- Low-income patients had significantly higher odds of MAE (AOR 1.30), including infectious and respiratory complications.
- LI was associated with reduced costs and longer hospital stays.
Conclusions:
- Lowest income quartile pediatric patients face elevated risks of major adverse events post-appendectomy.
- Socioeconomic status is a significant factor influencing pediatric appendectomy outcomes.
- Development of risk stratification and standardized care pathways is essential to reduce these disparities.
Background:
Appendectomy remains a common pediatric surgical procedure with an estimated 80,000 operations performed each year. While prior work has reported the existence of racial disparities in postoperative outcomes, we sought to characterize potential income-based inequalities using a national cohort.
Methods:
All non-elective pediatric (<18 years) hospitalizations for appendectomy were tabulated in the 2016-2020 National Inpatient Sample. Only those in the highest (HI) and lowest income (LI) quartiles were considered for analysis. Multivariable regression models were developed to assess the independent association of income and postoperative major adverse events (MAE).
Results:
Of an estimated 87,830 patients, 36,845 (42.0%) were HI and 50,985 (58.0%) were LI. On average, LI patients were younger (11 [7-14] vs 12 [8-15] years, P < .001), more frequently insured by Medicaid (70.7 vs 27.3%, P < .05), and more commonly of Hispanic ethnicity (50.8 vs 23.4%, P < .001). Following risk adjustment, the LI cohort was associated with greater odds of MAE (adjusted odds ratio [AOR] 1.30 95% confidence interval [CI] 1.06-1.64). Specifically, low-income status was linked with increased odds of infectious (AOR 1.65, 95% CI 1.12-2.42) and respiratory (AOR 1.67, 95% CI 1.06-2.62) complications. Further, LI was associated with a $1670 decrement in costs ([2220-$1120]) and a +.32-day increase in duration of stay (95% CI [.21-.44]).
Conclusion:
Pediatric patients of the lowest income quartile faced increased risk of major adverse events following appendectomy compared to those of highest income. Novel risk stratification methods and standardized care pathways are needed to ameliorate socioeconomic disparities in postoperative outcomes.
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