Language Barriers in Appendicitis: What is the Cost?

Area of Science:

• Pediatric Surgery
• Health Services Research
• Health Equity

Background:

• Pediatricians often rely on patient history to diagnose appendicitis, minimizing radiation exposure.
• Language barriers for patients with limited English proficiency (LEP) can negatively impact outcomes, increase imaging use, and raise costs for pediatric appendicitis.
• Effective communication is vital for accurate diagnosis and efficient care in pediatric surgery.

Purpose of the Study:

• To compare healthcare utilization and costs for pediatric appendicitis patients with and without limited English proficiency.
• To identify disparities in diagnostic workup, length of stay, and hospital costs based on primary language.
• To inform strategies for reducing healthcare inequities in pediatric surgical care.

Main Methods:

• Analysis of the pediatric-National Surgical Quality Improvement Project database (2011-2021) at a single institution.
• Propensity matching of patients under 16 undergoing appendectomy based on demographics and insurance.
• Comparison of outcomes including hospitalization cost, length of stay, and imaging usage between English proficient (EP) and limited English proficiency (LEP) cohorts.

Main Results:

• Patients with limited English proficiency (LEP) showed higher rates of diagnostic imaging compared to English proficient (EP) patients.
• The LEP cohort experienced longer median length of stay and higher median hospital costs, including imaging costs.
• English proficient (EP) patients had higher rates of negative appendectomy compared to the LEP cohort.

Conclusions:

• Language barriers in pediatric appendicitis care contribute to increased healthcare utilization and costs.
• Disparities in care related to language diversity necessitate targeted interventions for equitable health outcomes.
• Improving communication strategies is essential to ensure equitable and efficient delivery of pediatric surgical services.