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Determinants of surgical approach to pediatric appendicitis in Brazil
Ayla Gerk1,2,3, Paulo Henrique Moreira Melo4, Mohsen Amoei5,6
1Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada. ayla.gerkrangel@mail.mcgill.ca.
Insights
Pediatric appendectomy in Brazil is influenced by social factors like race and hospital resources, not disease severity. This highlights disparities in surgical care access for children.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Socioeconomic Determinants of Health
Background:
- Appendicitis is the most common surgical emergency in children.
- Understanding factors influencing surgical approach is crucial for equitable care.
Purpose of the Study:
- To investigate social and clinical determinants of surgical approach in pediatric appendectomy in Brazil.
- To identify disparities in surgical care for pediatric appendicitis.
Main Methods:
- Analysis of a national healthcare database for pediatric appendectomies in Brazil (2022).
- Inclusion of patient demographics, hospital resources, and location data.
- Application of univariable and multivariable logistic regression models.
Main Results:
- A total of 24,088 pediatric appendectomies were analyzed.
- Laparoscopic appendectomy was associated with white race, higher socioeconomic status, advanced hospital facilities, and Southern region location.
- Appendicitis severity did not significantly influence surgical approach.
Conclusions:
- Social determinants, not disease severity, significantly impact surgical approach for pediatric appendectomy in Brazil.
- Findings underscore the need for interventions to promote equitable healthcare access and surgical practices.
Introduction:
Appendicitis is the most prevalent surgical emergency in children. This study explores the social and clinical determinants affecting the surgical approach for pediatric appendectomy in Brazil.
Methods:
All patients aged 0-16 years hospitalized and operated on for acute appendicitis in Brazil during 2022 were identified in the Brazilian national healthcare database. Data reviewed included patient demographics, hospital resources and location. Univariable and multivariable logistic regression models were used for statistical analysis.
Results:
We identified 24,088 patients, of which 8768 (36.4%) were female, with a mean age of 10 years. 9690 (40.2%) of patients were white and 14.398 (59.8%) were non-white (including brown, black, asian or indigenous). Geographically, more patients were from the Southeast region. 21,627 (89.8%) of cases were open appendectomies. On univariable analysis, factors significantly influencing the selection of laparoscopic appendectomy included being female, white race, and higher socioeconomic status. The severity of appendicitis did not significantly affect the surgical approach. On multivariable analysis, white race (OR 1.934, [1.759, 2.126]), advanced hospital facilities (OR 5.987, [5.395, 6.644]), and hospitals located in the wealthier Southern region (OR 4.277, [3.884, 4.710]) were significant predictors of a laparoscopic approach.
Conclusion:
The surgical approach for pediatric appendectomy in Brazil was determined by social determinants rather than by disease severity. The findings emphasize the need for targeted interventions to ensure equitable healthcare access and approaches in pediatric surgery.
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