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This study was conducted to assess whether race and socioeconomic status influence the management method used to treat pediatric perforated appendicitis. Nonelective pediatric admissions with a primary diagnosis of appendicitis were analyzed using data from the 2001-2010 Nationwide Inpatient Sample. Bivariate and multivariate analyses were used to determine the association between race, insurance status, median household income, rural/metropolitan location, and the risk adjusted odds of undergoing surgery, laparoscopic appendectomy, percutaneous drainage, or neither surgery nor percutaneous drainage. A total of 46,211 admissions of perforated appendicitis were identified. Surgery was performed in 90.5 per cent of them. Black children were less likely to have surgery [adjusted odds ratio (AOR) = 0.53] and more likely to be managed nonsurgically with percutaneous drainage (AOR = 1.79). Self-pay patients were less likely to have laparoscopic surgery (AOR = 0.80). Children from rural counties were more likely to undergo surgery than those from larger metropolitan areas (AOR = 1.30). Higher estimated household income did not predict the method of treatment. Although previous studies have attributed racial disparities in outcomes for appendicitis to different rates of perforation and access to care, these findings demonstrate significantly dissimilar management strategies for patients presenting with a similar disease process.

Background: Differences in perforated appendix admission rates (PAAR) are an ambulatory-sensitive measure of access to care. While pediatric studies report disparities in PAAR, initial adult investigations suggest a lack of racial/ethnic inequity. The objectives of this study were to (1) assess for risk-adjusted, racial/ethnic differences in PAAR among adults on a national scale, (2) consider the extent to which variations (or lack thereof) are explained by age, insurance, and income, and (3) compare results within the United States population to a national segment of the population who are completely insured., Methods: According to the Agency for Healthcare Research and Quality definition of PAAR, adults (aged 18-64 years) in the 2006-2010 Nationwide Inpatient Sample were queried for the occurrence and perforation of acute appendicitis. Risk-adjusted differences were compared by race/ethnicity over 5-year age increments using logistic regression with reweighted estimating equations. Noting disparate outcomes between younger (aged 18-34 years) versus older (aged 35-64 years) adults, age-stratified variations were further considered. Results were compared relative to differences among national military/civilian-dependent patients with universal insurance and were assessed for the extent to which disparities could be explained by variations in insurance and income., Results: A total of 129,257 (weighted: 638,452) patients were included. Despite a lack of differences overall, significantly worse outcomes among younger (odds ratio point-estimates ranged from 1.11-1.32) and better outcomes among older (0.78-0.93) minority patients were found. This observation contrasted a lack of differences among completely insured military/civilian-dependent patients (n = 12,154). A total of 22.4% (non-Hispanic black versus non-Hispanic white) and 39.0% (Hispanic versus non-Hispanic white) of younger adult differences were explained by insurance-12.2% and 13.6% by income, 29.8% and 44.0% combined., Conclusion: This national assessment of differences in access to care among adults with acute appendicitis demonstrated the existence of racial/ethnic disparities in PAAR that varied with age and were partially, although incompletely, explained by variations in insurance and income., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Delay in presentation is associated with increased perforation rates in acute appendicitis. Perforation is linked to greater morbidity, and greater risk of complications. The purpose of this study is to evaluate whether ethnicity or insurance status is associated with differences in presentation and outcomes in adult patients with acute appendicitis., Materials and Methods: A retrospective analysis was performed for all patients 18 y of age and over with acute appendicitis between July 1, 2005 and December 31, 2008 at the only teaching hospital in the region. χ(2) and regression analyses were used to evaluate the impact of ethnicity and insurance status on perforation rates., Results: A total of 1003 patients with acute appendicitis were identified, of which 239 (23.8%) were perforated. Those patients with public insurance were significantly more likely to have perforated disease (P < 0.001). Additionally, those patients in the older age groups (41-64 and ≥65) were also significantly more likely (P < 0.001) to have perforated appendicitis (35.8% and 38.24%, respectively, versus 19.2% for those 18-40). The patients who presented with perforation had a greater length of stay (2.71 ± 2.14 versus 6.04 ± 3.91 d, P < 0.001)., Conclusions: In our population sample, ethnicity does not predict perforation rates in adult patients with acute appendicitis. Significant risks of perforation appear related to insurance status and age., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Delay in treatment is a strong risk factor for perforation during acute appendicitis. In addition, lower socioeconomic status has been linked to impaired access to surgical care. We sought to examine the relationships among race, insurance status, and perforation in a recent, adult population with acute appendicitis., Study Design: Data on adult patients with acute appendicitis were abstracted from the New York State Statewide Planning and Cooperative Systems Database for the years 2003 and 2004. A multiple logistic regression model, which adjusted for patient, community, and hospital factors, was used to examine the independent effects of both race and insurance status on likelihood of perforation., Results: A total of 29,637 patients had acute appendicitis; 7,969 (26.9%) of these were perforated. Although Caucasian patients were more likely to perforate compared with minority patients, by univariate analysis, adjustment for age alone eliminated this disparity. In addition, by multivariable analysis, no difference existed in odds of perforation for Caucasian patients compared with African-American (odds ratio [OR]=1.03, 95% CI [0.93, 1.15], p=0.52), Hispanic (OR=0.99, 95% CI [0.90, 1.08], p=0.82), or Asian patients (OR=0.85, 95% CI [0.73, 1.00], p=0.05). But compared with privately insured patients, uninsured patients (OR 1.18, 95% CI [1.07 to 1.30], p=0.0005), Medicaid patients (OR=1.22, 95% CI [1.12 to 1.33], p < 0.0001), and Medicare patients (OR=1.14, 95% CI [1.03, 1.25], p=0.01) were significantly more likely to have perforation., Conclusions: Race does not appear to be an important variable in predicting perforation in adult patients with acute appendicitis, but the likelihood of perforation varies significantly according to insurance status. Future research is necessary to both understand and have an impact on this socioeconomic disparity.

Objective: The objective of this study was to determine the relationship of race and socioeconomic factors and the method used for appendectomies in children (open vs. laparoscopic)., Summary Background Data: Previous studies have shown racial and insurance-related differences associated with the management of appendicitis in adults. It is not known whether these differences are observed in children., Methods: Children (<15 years) undergoing appendectomy from 1996 to 2002 were identified in the Nationwide Inpatient Sample. Severity of appendicitis and underlying chronic illnesses were determined by ICD-9 codes. Hospital characteristics evaluated included teaching status and location, children's hospital status, and volume of appendectomies. Hierarchical unadjusted and risk-adjusted logistic regression analyses were performed., Results: Among 72,189 children undergoing an appendectomy for appendicitis, 11,714 (16%) underwent a laparoscopic appendectomy. Multivariate analysis showed that whites were more likely to undergo a laparoscopic appendectomy than blacks (odds ratio, 1.14; 95% CI, 1.03-1.25, P = 0.01) but not other races. A significant interaction between payer source and children's hospital designation was observed, with the odds of children with private insurance undergoing laparoscopic appendectomy being significantly higher than those without private insurance at nonchildren's hospitals but not at children's hospitals., Conclusions: There are significant racial and insurance-related differences in use of laparoscopic appendectomy in children that are most evident at nonchildren's hospitals. These findings provide evidence that factors at hospitals dedicated to children may lead to better access to new technologies.

Background: Studies have shown that racial and socioeconomic differences lead to inequality in access to health care. It is unknown whether insurance status and race affect the choice of surgical treatment for patients presenting with appendicitis., Study Design: Patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy were selected from the 1998, 1999, and 2000 Nationwide (US) Inpatient Samples. The primary predictor variables were insurance status (private, Medicare, Medicaid, other) and race (Caucasian, African American, Hispanic, other). Multiple logistic regression models were used to assess whether insurance status and race are associated with the choice of surgical procedure for patients presenting with appendicitis., Results: Discharge abstracts of 145,546 patients were used for our analyses. There were 32,407 patients (22.3%) who underwent laparoscopic appendectomy and 113,139 patients (77.7%) who had open appendectomy. Although 24.2% of privately insured patients underwent laparoscopic appendectomy, only 16.9% of Medicare patients, 17.4% of Medicaid patients, and 19.6% of patients in the "other" insurance category were treated using the laparoscopic procedure (p < 0.001). Caucasian patients underwent laparoscopic surgery in 24.8%, African Americans in 18.6%, Hispanics in 19.6%, and other ethnicities in 18.8% of patients (p < 0.001). Compared with the Medicaid subset, and after adjusting for potential confounders such as age, gender, race, patient comorbidity, median ZIP code income, hospital location and teaching status, and presence of abscess or perforation, privately insured patients (odds ratio [OR] = 1.26, 95% [CI [1.20, 1.33], p < 0.001) and Medicare patients (OR = 1.17, 95% CI [1.05, 1.30], p = 0.004) were significantly more likely to undergo laparoscopic surgery. Caucasian patients (OR = 1.42, 95% CI [1.33, 1.51], p < 0.001) and Hispanics (OR = 1.12, 95% CI [1.04, 1.20], p = 0.002) were significantly more likely to have laparoscopic appendectomy, compared with African Americans, even after adjusting for the previously mentioned confounders and insurance status., Conclusions: Even after adjusting for potential confounders, insurance status and race are marked independent predictors of having laparoscopic surgery in patients treated for appendicitis in this sample.