Laparoscopic appendectomy in children with complicated appendicitis: ethnic disparity amid changing trend.

Creator(s)

Tolulope A. Oyetunji, Children's Mercy HospitalFollow
Benedict C. Nwomeh
Sharon K. Ong'uti
Dani O. Gonzalez
Edward E. Cornwell
Terrence M. Fullum

Document Type

Article

Publication Date

9-1-2011

Identifier

DOI: 10.1016/j.jss.2011.05.001

Abstract

BACKGROUND: Laparoscopic appendectomy (LA) has gained acceptance in the treatment of uncomplicated appendicitis in the pediatric population. The role of LA versus open appendectomy (OA) in complicated (perforated) appendicitis has remained controversial.

METHODS: A 10-y review of the Nationwide Inpatient Sample (HCUP-NIS) and 3 y of non-overlapping data from the Kids' Inpatient Database (KID) (2000, 2003, and 2006) was performed on pediatric patients (agey) with complicated appendicitis. Patients were classified based on gender, race, insurance status, and type of appendectomy performed. Multivariate regression was conducted adjusting for age, race, gender, and type of appendectomy, with mortality and length of hospital stay (LOS) as outcomes.

RESULTS: An estimated 72,787 patients met the inclusion criteria with a median age of 11 y. The majorities of the patients were male (59.9%), Caucasian (38.1%), and insured (89.7%). Twenty-nine percent underwent LA while 71% had OA. Proportion of LA increased from 9.9% in 1999 to 46.6% in 2007. On multivariate analysis, African-Americans were less likely to undergo LA compared with Caucasians (OR: 0.80, CI = 0.69-0.92, P = 0.002) despite an increased odds of undergoing LA over the last decade from 1998 to 2007 in the entire study population (OR 6.27, 95% CI 4.73-8.30, P = 0.000). Increasing age and gender were also associated with likelihood of receiving LA (OR: 1.08, CI = 1.06-1.10 and OR 1.25, 95% CI 1.18-1.31, P < 0.001).

CONCLUSIONS: LA is gradually gaining acceptance over the years as an alternative to OA for complicated appendicitis, However, minority difference still exists in choice of procedure. There is a need to further investigate this disparity as it may be related to access to skilled laparoscopic pediatric surgeons.

Journal Title

The Journal of surgical research

Volume

170

Issue

1

First Page

99

Last Page

103

MeSH Keywords

Adolescent; African Americans; Age Factors; Appendectomy; Appendicitis; Child; European Continental Ancestry Group; Female; Healthcare Disparities; Humans; Laparoscopy; Length of Stay; Male; Multivariate Analysis; Retrospective Studies

Keywords

Appendicitis; Surgery; Child; Teenager; Ethnic Groups; Race; Laparoscopic; Inequality

Comments

Comment in

• Impact of race/ethnicity and insurance status on outcomes for appendicitis in children. [J Surg Res. 2012]

Recommended Citation

Oyetunji, T. A., Nwomeh, B. C., Ong'uti, S. K., Gonzalez, D. O., Cornwell, E. E., Fullum, T. M. Laparoscopic appendectomy in children with complicated appendicitis: ethnic disparity amid changing trend. The Journal of surgical research 170, 99-103 (2011).