Differences in the Management of Perforated Appendicitis in Children by Race and Insurance Status

Lassiter, Randi; Hatley, Robyn M.

doi:10.1177/000313481708300937

Cited by 16 publications

(7 citation statements)

References 19 publications

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“…Delays in diagnosis and treatment of surgical conditions are associated with increased health system costs and worse outcomes for patients . In acute appendicitis, racial and ethnic disparities occur in presentation, treatment, and outcomes . In children, delayed diagnosis may account for higher rates of perforation at presentation .…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] In acute appendicitis, racial and ethnic disparities occur in presentation, treatment, and outcomes. [6][7][8][9][10] In children, delayed diagnosis may account for higher rates of perforation at presentation. 7,11 In a multicenter study by Goyal et al, 7 non-Hispanic Black children with appendicitis were more likely to have a delayed or missed diagnosis of appendicitis, less likely to undergo any imaging, and more likely to present with perforated appendicitis compared with non-Hispanic White children.…”

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confidence: 99%

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Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

et al. 2023

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ImportanceRacial disparities in timely diagnosis and treatment of surgical conditions exist; however, it is poorly understood whether there are hospital structural measures or patient-level characteristics that modify this phenomenon.ObjectiveTo assess whether patient race and ethnicity are associated with delayed appendicitis diagnosis and postoperative 30-day hospital use and whether there are patient- or systems-level factors that modify this association.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used data from the Healthcare Cost and Utilization Project’s state inpatient and emergency department (ED) databases from 4 states (Florida, Maryland, New York, and Wisconsin) for patients aged 18 to 64 years who underwent appendectomy from January 7, 2016, to December 1, 2017. Data were analyzed from January 1, 2016, to December 31, 2017.ExposureDelayed diagnosis of appendicitis, defined as an initial ED presentation with an abdominal diagnosis other than appendicitis followed by re-presentation within a week for appendectomy.Main Outcomes and MeasuresA mixed-effects multivariable Poisson regression model was used to estimate the association of delayed diagnosis of appendicitis with race and ethnicity while controlling for patient and hospital variables. A second mixed-effects multivariable Poisson regression model quantified the association of delayed diagnosis of appendicitis with postoperative 30-day hospital use.ResultsOf 80 312 patients who received an appendectomy during the study period (median age, 38 years [IQR, 27-50 years]; 50.8% female), 2013 (2.5%) experienced delayed diagnosis. In the entire cohort, 2.9% of patients were Asian or Pacific Islander, 18.8% were Hispanic, 10.9% were non-Hispanic Black, 60.8% were non-Hispanic White, and 6.6% were other race and ethnicity; most were privately insured (60.2%). Non-Hispanic Black patients had a 1.41 (95% CI, 1.21-1.63) times higher adjusted rate of delayed diagnosis compared with non-Hispanic White patients. Patients at hospitals with a more than 50% Black or Hispanic population had a 0.73 (95% CI, 0.59-0.91) decreased adjusted rate of delayed appendicitis diagnosis compared with hospitals with a less than 25% Black or Hispanic population. Conversely, patients at hospitals with more than 50% of discharges of Medicaid patients had a 3.51 (95% CI, 1.69-7.28) higher adjusted rate of delayed diagnosis compared with hospitals with less than 10% of discharges of Medicaid patients. Additional factors associated with delayed diagnosis included female sex, higher levels of patient comorbidity, and living in a low-income zip code. Delayed diagnosis was associated with a 1.38 (95% CI, 1.36-1.61) increased adjusted rate of postoperative 30-day hospital use.Conclusions and RelevanceIn this cohort study, non-Hispanic Black patients had higher rates of delayed appendicitis diagnosis and 30-day hospital use than White patients. Patients presenting to hospitals with a greater than 50% Black and Hispanic population were less likely to experience delayed diagnosis, suggesting that seeking care at a hospital that serves a diverse patient population may help mitigate the increased rate of delayed diagnosis observed for non-Hispanic Black patients.

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Section: Introductionmentioning

confidence: 99%

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Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

et al. 2023

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“…Acute appendicitis may result in complications that endanger life. Appendicectomy is the communal accomplished emergency abdominal surgical procedure in various regions of the world [3][4] . Appendicectomy is mostly performed by young surgical residents in major part of the world.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Treatment of Perforated Appendicitis

Aslam¹,

Iqbal²,

Abbas³

et al. 2023

PJMHS

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The most frequent general surgical emergency worldwide is acute appendicitis. Because to its potentially fatal complications, including perforation, it could put patients at danger of death. An appendix that has ruptured frequently results in serious infectious complications as abdominal sepsis, pelvic abscess, and others. Laparoscopic appendectomy for perforated appendicitis raises several questions. In many nations today, laparoscopic treatment of perforated appendicitis is the preferred surgical technique. Aim: This prospective study's objective was to assess the efficacy of laparoscopy in the treatment of complicated appendicitis (perforation). Methods: The study was conducted prospectively during the period from September 2020 to August 2022. The study included 50 individuals who underwent peritoneal lavage after laparoscopic appendicectomy of perforated appendix in the department of Surgery, Lady Reading Hospital, Peshawar. The traditional method, three ports technique was used. Sometimes a fourth port is needed. Telescopic ports are 10 mm in size. The other two ports are 3/5 mm and 5/10 mm, respectively. Unipolar diathermy is a source of energy. Hemostasis and ligation of the appendicular stump are achieved via intra-corporeal knotting, endo-loop, and hemo-clip. Results: The study's age range is 5-70 years, with a mean age of 19 with male predominance. The duration of surgery varies from 30 to 120 minutes, with a mean duration of 65 minutes. Hospital stays range from 48 to 96 hours on average. There were 12 patients with complications, including paralytic ileus was seen in 1(2%), diarrhea in 2(4%), multiple or single (4% and 8%) port infections, and port TB in (4%). Open conversion was seen in 1 (2%) patient due to appendicitis burst haemorrhage. Every complication was treated carefully. Conclusion: Laparoscopy is an excellent method for treating perforated appendicitis. Thus, it is practical, achievable and may be carried out by skilled hands in any centre. That is now regarded as regular operating procedure. Keywords: Laparoscopic appendicectomy, Perforation (burst)

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“…Appendicitis is one of the most common emergencies in childhood, and the vast majority are treated surgically [1][2][3]. Approximately 7% of children presenting to emergency rooms with abdominal pain have acute appendicitis [4].…”

Section: Introductionmentioning

confidence: 99%

“…In a recent study utilizing disparities analytic files from 2015, 45% of pediatric appendicitis cases exhibited perforation as a major complication [2]. Hispanic and African American populations demonstrate an increased incidence of perforated appendicitis [3]. Ladd et al reported increased rates of complications in Hispanic versus African American children, regardless of timing of diagnosis [5].…”

Section: Introductionmentioning

confidence: 99%

Identification of Bias in Ordering Further Imaging in Ethnic Groups With Indeterminate Ultrasound for Appendicitis

Desai¹,

Haut²,

Wagers³

et al. 2022

Cureus

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BackgroundRecent studies have shown a higher incidence of complications from acute appendicitis in Hispanic populations. Hispanic ethnicity alone has been shown to be a risk factor. In contrast, one study found little evidence of racial disparities in complication rates. The objective of this study was to identify physician bias regarding whether ethnicity drives further testing after initial radiologic imaging has been obtained in the evaluation of appendicitis in our pediatric emergency department (PED). The use of computed tomography (CT) scan in the diagnosis of appendicitis was compared between Hispanic versus non-Hispanic populations when ultrasound (US) was indeterminate. MethodologyThis is a retrospective cohort study of Hispanic and non-Hispanic patients aged 2-18 who presented to the PED with right lower quadrant abdominal pain over a one-year period (January 1, 2017 to December 29, 2017). Both groups were subdivided into positive, negative, or indeterminate US findings for appendicitis. Each subgroup was analyzed based on those who had CT imaging done. ResultsA total of 471 ultrasounds were performed, 162 Hispanic and 309 non-Hispanic patients. Indeterminate US scans were documented in 90/162 (56%) Hispanic versus 155/309 (50%) non-Hispanic patients. Of those with indeterminate US scans, 30% Hispanic versus 32% non-Hispanic patients received CT scans. Negative US scans were documented in 54/162 (33%) Hispanic versus 102/309 (33%) non-Hispanic patients. Of those with negative US scans, 7% Hispanic versus 5% non-Hispanic patients received CT scans. Chi-square analysis comparing both the proportion of CT scans received for indeterminate US scans (p=0.71) and negative US scans (p=0.52) showed no statistical significance. ConclusionsThere was no significant difference in the number of CT scans ordered for indeterminate US scans between Hispanic and non-Hispanic patients. One can infer that there is no inherent bias toward ordering advanced imaging in Hispanic children based on ethnicity alone.

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Differences in the Management of Perforated Appendicitis in Children by Race and Insurance Status

Cited by 16 publications

References 19 publications

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

Laparoscopic Treatment of Perforated Appendicitis

Identification of Bias in Ordering Further Imaging in Ethnic Groups With Indeterminate Ultrasound for Appendicitis

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