Effect of Race and Socioeconomic Status in the Treatment of Appendicitis in Patients With Equal Health Care Access

Lee, Steven L.; Shekherdimian, Shant; Chiu, Vicki

doi:10.1001/archsurg.2010.328

Cited by 51 publications

(38 citation statements)

References 22 publications

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“…24-26 However, these studies into impaired access and perforation have not produced consistent results. For instance, Pieracci et al, 27 Boomer et al, 14 and Lee et al 28 all found that, compared with white adults, other racial and ethnic groups had lower or similar odds of perforation (as did the current study). Moreover, many studies in the pediatric literature contradict one another in terms of which races or ethnicities have higher or lower proportions of perforation.…”

Section: Discussionsupporting

confidence: 70%

Time to Appendectomy and Risk of Perforation in Acute Appendicitis

et al. 2014

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IMPORTANCE In the traditional model of acute appendicitis, time is the major driver of disease progression; luminal obstruction leads inexorably to perforation without timely intervention. This perceived association has long guided clinical behavior related to the timing of appendectomy. OBJECTIVE To evaluate whether there is an association between time and perforation after patients present to the hospital. DESIGN, SETTING, AND PARTICIPANTS Using data from the Washington State Surgical Care and Outcomes Assessment Program (SCOAP), we evaluated patterns of perforation among patients (≥18 years) who underwent appendectomy from January 1, 2010, to December 31, 2011. Patients were treated at 52 diverse hospitals including urban tertiary centers, a university hospital, small community and rural hospitals, and hospitals within multi-institutional organizations. MAIN OUTCOMES AND MEASURES The main outcome of interest was perforation as diagnosed on final pathology reports. The main predictor of interest was elapsed time as measured between presentation to the hospital and operating room (OR) start time. The relationship between in-hospital time and perforation was adjusted for potential confounding using multivariate logistic regression. Additional predictors of interest included sex, age, number of comorbid conditions, race and/or ethnicity, insurance status, and hospital characteristics such as community type and appendectomy volume. RESULTS A total of 9048 adults underwent appendectomy (15.8% perforated). Mean time from presentation to OR was the same (8.6 hours) for patients with perforated and nonperforated appendicitis. In multivariate analysis, increasing time to OR was not a predictor of perforation, either as a continuous variable (odds ratio = 1.0 [95% CI, 0.99-1.01]) or when considered as a categorical variable (patients ordered by elapsed time and divided into deciles). Factors associated with perforation were male sex, increasing age, 3 or more comorbid conditions, and lack of insurance. CONCLUSIONS AND RELEVANCE There was no association between perforation and in-hospital time prior to surgery among adults treated with appendectomy. These findings may reflect selection of those at higher risk of perforation for earlier intervention or the effect of antibiotics begun at diagnosis but they are also consistent with the hypothesis that perforation is most often a prehospital occurrence and/or not strictly a time-dependent phenomenon. These findings may also guide decisions regarding personnel and resource allocation when considering timing of nonelective appendectomy.

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Section: Discussionsupporting

confidence: 70%

Time to Appendectomy and Risk of Perforation in Acute Appendicitis

et al. 2014

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“…Studies have assessed what factors account for differences in LOS after appendectomy across ethnicity in both adult [25] and pediatric [26] patients, but the relationship between ethnicity and LOS remains unclear in the literature. Differences may be attributed to culture differences, home dynamics, and socioeconomic factors, but future work is necessary to clarify exactly what factors influence LOS across ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

Variability in same-day discharge for pediatric appendicitis

Oyetunji

Gonzalez

Aguayo

et al. 2015

Journal of Surgical Research

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“…Within pediatric surgery, study of appendicitis outcomes in children has identified increased incidences of perforation in black and Hispanic children compared to children of white race, a difference not explained by measurable factors within the Healthcare Cost and Utilization Project database[30]. While it has been suggested that equal access to care eliminates disparities in outcomes for patients with appendicitis, this and other studies suggest multi-factorial influences within race-related healthcare disparities[1, 31]. In addition to access limitations, developmental genetics and environmental influences have been suggested as potential factors involved in race-related disparities in the analysis of surgical site infections and each merit consideration in the assessment of race and healthcare outcomes[32].…”

Section: Discussionmentioning

confidence: 99%

The effect of race and gender on pediatric surgical outcomes within the United States

Stone

LaPar

Kane

et al. 2013

Journal of Pediatric Surgery

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Purpose The purpose of this study was to examine risk-adjusted associations between race and gender on postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States. Methods 91,891 pediatric surgical patients were evaluated using the U.S. national KID Inpatient Database (2003 and 2006): appendectomy (81.2%), pyloromyotomy (9.8%), intussusception (6.2%), decortication (1.9%), congenital diaphragmatic hernia repair (0.7%), and colonic resection for Hirschsprung’s disease (0.2%). Patients were stratified according to gender (male: 62.6%, n=57,557) and race: white (n=52,334), Hispanic (n=25,697), black (n=6,951), Asian (n=1,855), Native American (n=470), and other (n=4,584). Multivariable logistic regression modeling was utilized to evaluate risk-adjusted associations between race, gender, and outcomes. Results After risk-adjustment, race was independently associated with in-hospital death (p=0.02), with an increased risk for black children. Gender was not associated with mortality (p=0.77). Post-operative morbidity was significantly associated with gender (p<0.001) and race (p=0.008). Gender (p=0.003) and race (p<0.001) were further associated with increased hospital length of stay. Importantly, these results were dependent on operation type. Conclusion Race and gender significantly affect post-operative outcomes following pediatric surgery. Black patients are at disproportionate risk for post-operative mortality, while black and Hispanic patients have increased morbidity and hospital resource utilization. While gender does not affect mortality, gender is a determinant of both post-operative morbidity and increased resource utilization.

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Effect of Race and Socioeconomic Status in the Treatment of Appendicitis in Patients With Equal Health Care Access

Cited by 51 publications

References 22 publications

Time to Appendectomy and Risk of Perforation in Acute Appendicitis

Time to Appendectomy and Risk of Perforation in Acute Appendicitis

Variability in same-day discharge for pediatric appendicitis

The effect of race and gender on pediatric surgical outcomes within the United States

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