Martha-Conley E Ingram1, Kristen Calabro2, Stephanie Polites3, Courtney McCracken4, Gudrun Aspelund5, Barrie S Rich6, Robert L Ricca7, Roshni Dasgupta3, David H Rothstein2, Mehul V Raval8. 1. Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. 2. Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences and John R. Oishei Children's Hospital, Buffalo, New York. 3. Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 4. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 5. Department of Surgery, Maria Fareri Children's Hospital, New York, New York. 6. Division of Pediatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, New York. 7. Department of Surgery, Naval Medical Center, Portsmouth, Virginia. 8. Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: mraval@luriechildrens.org.
Abstract
BACKGROUND: The impact of social, racial, and economic inequities on health and surgical outcomes for children is poorly described. METHODS: A systematic review using search terms related to disparities in care of pediatric appendicitis identified 20 titles and narrowed to 11 full texts. Nine retrospective studies were analyzed, representing 350,408 cases treated across the United States from 1983 to 2010. Outcomes included length of stay (LOS), appendiceal perforation rate (AP), laparoscopic versus open approach, and rate of misdiagnosis. RESULTS: The most frequently reported outcomes were LOS (six of nine studies) and AP (six of nine studies). AP was higher for young children (48% for <6 versus 25% for >10), those in rural settings (42% versus 26% in urban settings), and patients receiving care at children's hospitals (35% versus 22% at nonchildren's hospitals). Longer LOS was associated with young age in three studies (2-5 d for age <10 y versus 1-3 d for age >11 y), race in four studies (1.5-3 d for African American children versus 1-2 d for other races), and lower family income in two studies (2-4 d versus 1-3 d for highest income). Inequitable use of laparoscopy, time to surgery, and rates of misdiagnosis were also reported to be associated with age and race. CONCLUSIONS: Although limited, the existing literature suggests that social, racial, and economic inequalities impact management and outcomes in pediatric appendicitis. More studies are needed to better describe and mitigate disparities in the surgical care of children.
BACKGROUND: The impact of social, racial, and economic inequities on health and surgical outcomes for children is poorly described. METHODS: A systematic review using search terms related to disparities in care of pediatric appendicitis identified 20 titles and narrowed to 11 full texts. Nine retrospective studies were analyzed, representing 350,408 cases treated across the United States from 1983 to 2010. Outcomes included length of stay (LOS), appendiceal perforation rate (AP), laparoscopic versus open approach, and rate of misdiagnosis. RESULTS: The most frequently reported outcomes were LOS (six of nine studies) and AP (six of nine studies). AP was higher for young children (48% for <6 versus 25% for >10), those in rural settings (42% versus 26% in urban settings), and patients receiving care at children's hospitals (35% versus 22% at nonchildren's hospitals). Longer LOS was associated with young age in three studies (2-5 d for age <10 y versus 1-3 d for age >11 y), race in four studies (1.5-3 d for African American children versus 1-2 d for other races), and lower family income in two studies (2-4 d versus 1-3 d for highest income). Inequitable use of laparoscopy, time to surgery, and rates of misdiagnosis were also reported to be associated with age and race. CONCLUSIONS: Although limited, the existing literature suggests that social, racial, and economic inequalities impact management and outcomes in pediatric appendicitis. More studies are needed to better describe and mitigate disparities in the surgical care of children.
Authors: Peter C Minneci; Erinn M Hade; Gregory A Metzger; Jacqueline M Saito; Grace Z Mak; Katherine J Deans Journal: JAMA Date: 2021-06-22 Impact factor: 56.272
Authors: Megan E Bouchard; Kristin Kan; Yao Tian; Mia Casale; Tracie Smith; Christopher De Boer; Samuel Linton; Fizan Abdullah; Hassan M K Ghomrawi Journal: JAMA Netw Open Date: 2022-02-01