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Surgical delay in appendicitis among children: the role of social vulnerability
Villa-Aguilar Estefany1, Marín-Morales Karen1, Ayala-Galvan Citlali1
1Centro de Investigación Traslacional, Instituto Nacional de Pediatría, Mexico City, Mexico.
Insights
Delayed surgical care for pediatric appendicitis, especially in uninsured children, leads to complicated appendicitis (CA). Social vulnerability significantly increases the risk of CA, highlighting the need to address both medical and social factors for timely treatment.
Area of Science:
- Pediatric Surgery
- Public Health
- Health Services Research
Background:
- Appendicitis is a common pediatric surgical emergency, often used as a quality indicator for timely care.
- Complicated appendicitis (CA) incidence remains high due to delays in pediatric surgical care.
- Social vulnerability is linked to surgical access, particularly in low- and middle-income populations.
Purpose of the Study:
- To examine the relationship between surgical delay and social determinants of complicated appendicitis in children without social security in Mexico.
- To identify factors contributing to delays in pediatric surgical care for appendicitis.
Main Methods:
- Retrospective cohort study of 943 pediatric appendicitis cases (2018-2021) at a public hospital.
- Primary outcome: appendicitis type (acute/complicated). Independent variables: time of evolution and socioeconomic factors.
- Logistic regression analysis to assess the relationship between appendicitis type and covariates.
Main Results:
- 62.67% of pediatric appendicitis cases presented as complicated appendicitis (CA).
- Prehospital delay (≥48 hours) was associated with significantly higher odds of CA (OR 3.27).
- Children under 5 years old also had higher odds of CA (OR 1.76).
Conclusions:
- High rates of CA in uninsured children are linked to surgical delays exceeding two days.
- Social vulnerabilities impede access to quality pediatric surgical care.
- Appendicitis must be viewed as both a medical and social issue, necessitating comprehensive strategies addressing social determinants of health.
Background:
Appendicitis is the most common abdominal emergency in pediatrics and is suggested as a quality indicator for timely access to care in time-sensitive conditions. Despite advances in diagnostics, the incidence of complicated appendicitis (CA) remains high due to delays in pediatric surgical care, which can increase disease severity. Social vulnerability has been associated with surgical access, particularly in low- and middle-income populations. This study examines the relationship between surgical delay and social determinants of complicated appendicitis in children without social security in the Metropolitan Zone of México.
Methods:
This retrospective cohort study was conducted in a pediatric public hospital. Consecutive cases from 2018 to 2021 with confirmed appendicitis diagnoses were included. The primary outcome variable was the type of appendicitis (acute/complicated), while two independent variables were the time of evolution (patient and hospital timing) and socioeconomic factors associated with social vulnerability. A logistic regression analysis assessed the relationship between appendicitis type and covariates.
Results:
A total of 943 pediatric cases of appendicitis were included. Out of these, 62.67% presented CA, with a mean age 10 ± 4 years. 60.9% were well-nourished, and 16% had at least one comorbidity. Most subjects (76%) met at least two criteria for social vulnerability, and 74.7% of families held unskilled jobs. The median symptom-to-admission time was 2 days, with a median hospital-to-surgery time of 19.5 h (p25-p75). Prehospital delays affected 57.8% of cases (n = 545), and 39% (n = 365) experienced intrahospital delays. In the multivariable logistic regression, prehospital delay ≥48 h (OR 3.27, 95% CI 2.43-4.39) and children under 5 years (OR 1.76, 95% CI 1.09-2.84) were associated with higher odds of CA.
Conclusion:
The high frequency of CA in uninsured children at a public hospital is due to surgical delays of two or more days. Social vulnerabilities, as observed globally, hinder access to quality care. Thus, appendicitis should be recognized as both a medical and social issue, requiring a comprehensive approach that addresses social vulnerability.
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