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Evaluation of race and insurance status as predictors of undergoing laparoscopic appendectomy in children.

Hagendorf BA, Liao JG, Price MR, Burd RS

Department of Surgery, Division of Pediatric Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.

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.

Published 1 January 2007 in Ann Surg, 245(1): 118-25.
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