Study reports racial disparities in pediatric appendicitis treatment tied to hospital type

December 28, 2012, American College of Surgeons

When researchers from UCLA Medical Center investigated the link between racial disparities and appendicitis outcomes in children, they found that the type of hospital in which black, Hispanic and other minority patients receive care—community, children's or county—affects their odds of developing a perforated appendix. The study published in the January issue of the Journal of the American College of Surgeons is a first-of-its-kind look at the role hospital type plays in race-based treatment variances among this patient subset.

—a painful, inflamed appendix—is the most common reason for emergency in children. Approximately 80,000 pediatric cases are diagnosed in the U.S. annually.* Since the can sometimes become perforated if the condition is not treated in a timely fashion (usually one to two days from the time symptoms first appear), researchers have used appendix perforation as a marker for inadequate access to health care. While existing research shows that a number of factors (such as age, socioeconomic status, the distance a family lives from a hospital) increase the risk for developing a in minorities, these factors don't tell the whole story.

"Appendicitis is a time-dependent disease process that leads to more a complicated medical outcome, and that outcome, perforated appendicitis, has increased hospital costs and increased burden to both the patient and society," according to study author Stephen Shew, MD, FACS, associate professor of surgery, UCLA Medical Center, and a at Mattel Children's hospital, both in Los Angeles.

To determine whether there is a link between hospital type and racial disparities, as measured by appendiceal perforation (AP), Dr. Shew and colleagues looked at data from the California Patient Discharge Dataset. Their analysis involved 107,727 children between the ages of two and 18 years old who were treated for appendicitis at 386 California hospitals between 1999 and 2007. Of these children, 53 percent were Hispanic, 36 percent were white, 3 percent were black, 5 percent were Asian, and 8 percent were of an unknown race. The children were sorted by hospital type, which included community, children's and county hospitals.

After accounting for age, income level and other known factors that increase risk for a perforated appendix, researchers found that at community hospitals, Hispanic children were 23 percent more likely to experience appendix perforation than white children, and Asian children were 34 percent more likely than white children to experience appendix perforation. Further, Hispanic patients treated at children's hospitals were 18 percent more likely to develop this complication than white patients. Odds of appendix perforation did not differ by race within county hospitals. Researchers also found that black patients treated at children's and county hospitals had a higher risk of appendix perforation compared with black patients treated at community hospitals.

Beyond what the researchers already know about appendicitis outcomes in children, these findings indicate that hospital type does play an independent role in risk for perforated appendicitis, and that these disparities in appendicitis outcomes exist at different types of hospitals based upon race, Dr. Shew said. "The goal is to figure out why these exist and what interventions could be put in place to help eliminate them," he added.

Dr. Shew stressed that further research is still needed on a variety of issues, including whether there is a link between language barriers and understanding symptoms of appendicitis and access to care. "We don't know what explains these findings; however we suspect that there are some other barriers in play," Dr. Shew said. This discovery shows that a critical piece of the puzzle—what is happening with the child and the parents from the time they first discover the symptoms of appendicitis to the time they seek care—is still missing.

"As investigators it behooves us to look further into prehospital factors that may contribute to this racial disparity and ultimately find what interventions can be implemented to provide much quicker access to care, so can get treated more effectively," Dr. Shew said. "But we don't know for sure what would be most beneficial until we really know where the problem lies."

Explore further: Ultrasound diagnoses appendicitis without X-rays

More information: * Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910-925.

Citation: Journal of the American College of Surgeons, January 2012: Vol 216(1): 74-82.

Related Stories

Ultrasound diagnoses appendicitis without X-rays

December 27, 2012
Children suspected of having appendicitis are more likely to receive CT scans, which involve radiation, if they are evaluated at a general hospital, a new study by Washington University School of Medicine in St. Louis has ...

Cost study shows timing crucial in appendectomies

April 30, 2012
Removing a child's ruptured appendix sooner rather than later significantly lowers hospital costs and charges, according to a recently published study.

Surgery cuts costs, improves outcomes for children with perforated appendicitis

April 2, 2012
Pediatric surgeons can lower health care costs if they remove a young patient's perforated appendix sooner rather than later, according to new study results published in the April issue of the Journal of the American College ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.