Highlights
- •Children of minority race/ethnicity had higher odds of postdischarge emergency department visits after appendicitis treatment, but Hispanic/Latinx patients were not more likely to be readmitted.
- •Inverse Odds Weighted Mediation analyses were used to measure the influence of complicated disease, insurance, socioeconomic status, and urbanicity.
- •Different patterns of disparity mediation were demonstrated for non-Hispanic Black and Hispanic/Latinx patients.
- •Modifiable factors driving postdischarge surgical disparities in children demand focused study.
Abstract
Introduction
Significant racial and ethnic disparities exist for children presenting with acute
appendicitis; however, it is unknown if disparities persist after initial management
and hospital discharge.
Materials and Methods
We performed a retrospective cohort study of children (aged < 18 y) who underwent
treatment for acute appendicitis in 47 U.S. Children's Hospitals between 2017 and
2019. Primary outcomes were 30-d emergency department (ED) visits and 30-d inpatient
readmission. Hierarchical multivariable logistic regression models were developed
to determine the association of race and ethnicity on the primary outcomes. Inverse
odds-weighted mediation analyses were used to estimate the degree to which complicated
disease, insurance status, urbanicity, and residential socioeconomic status– mediated
disparate outcomes.
Results
A total of 67,303 patients were included. Compared with Non-Hispanic White children,
Non-Hispanic Black (NHB) (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.23-1.59)
and Hispanic/Latinx (HL) children (OR 1.55, 95% CI 1.44-1.67) had higher odds of ED
visits. Only NHB children had higher odds of readmission (OR 1.43, 95% CI 1.30-1.57).
On a multivariable analysis, NHB (adjusted OR 1.19, 95% CI 1.04-1.36) and HL (adjusted
OR 1.19, 95% CI 1.09-1.31) children had higher odds of ED visits. Insurance, disease
severity, socioeconomic status, and urbanicity mediated 61.6% (95% CI 29.7-100%) and
66.3% (95% CI 46.9-89.3%) of disparities for NHB and HL children, respectively.
Conclusions
Children of racial and ethnic minorities are more likely to visit the ED after treatment
for acute appendicitis, but HL patients did not have a corresponding increase in readmission.
These differences were mediated mainly by insurance status and urban residence. A
lack of appropriate postdischarge education and follow-up may drive disparities in
healthcare utilization after pediatric appendicitis.
Keywords
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Article info
Publication history
Published online: October 26, 2022
Accepted:
September 15,
2022
Received in revised form:
August 11,
2022
Received:
April 20,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
