Systematic Review of Disparities in Care and Outcomes in Pediatric Appendectomy

Martha Conley E. Ingram; Kristen Calabro; Stephanie Polites; Courtney McCracken; Gudrun Aspelund; Barrie S. Rich; Robert L. Ricca; Roshni Dasgupta; David H. Rothstein; Mehul V. Raval

doi:10.1016/j.jss.2019.12.018

Systematic Review of Disparities in Care and Outcomes in Pediatric Appendectomy

Martha Conley E. Ingram, Kristen Calabro, Stephanie Polites, Courtney McCracken, Gudrun Aspelund, Barrie S. Rich, Robert L. Ricca, Roshni Dasgupta, David H. Rothstein, Mehul V. Raval^*

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Review article › peer-review

53 Scopus citations

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.

Original language	English (US)
Pages (from-to)	42-49
Number of pages	8
Journal	Journal of Surgical Research
Volume	249
DOIs	https://doi.org/10.1016/j.jss.2019.12.018
State	Published - May 2020

Funding

The authors of this article would like to acknowledge John K Nemeth of Woodruff Health Sciences Library for his assistance with development of the search terms for this study and thank two anonymous peer reviewers for their assistance in providing editing support. The authors would also like to recognize to Children's Healthcare of Atlanta and Emory University Pediatric Biostatistics Core.

Keywords

Appendicitis
Children's health care
Disparity
Pediatric surgery
Surgical outcome

ASJC Scopus subject areas

Surgery

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10.1016/j.jss.2019.12.018

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@article{c35b56a2bc6242f69f5212e661fb9b2a,

title = "Systematic Review of Disparities in Care and Outcomes in Pediatric Appendectomy",

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.",

keywords = "Appendicitis, Children's health care, Disparity, Pediatric surgery, Surgical outcome",

author = "Ingram, {Martha Conley E.} and Kristen Calabro and Stephanie Polites and Courtney McCracken and Gudrun Aspelund and Rich, {Barrie S.} and Ricca, {Robert L.} and Roshni Dasgupta and Rothstein, {David H.} and Raval, {Mehul V.}",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2020",

month = may,

doi = "10.1016/j.jss.2019.12.018",

language = "English (US)",

volume = "249",

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T1 - Systematic Review of Disparities in Care and Outcomes in Pediatric Appendectomy

AU - Ingram, Martha Conley E.

AU - Calabro, Kristen

AU - Polites, Stephanie

AU - McCracken, Courtney

AU - Aspelund, Gudrun

AU - Rich, Barrie S.

AU - Ricca, Robert L.

AU - Dasgupta, Roshni

AU - Rothstein, David H.

AU - Raval, Mehul V.

PY - 2020/5

Y1 - 2020/5

N2 - 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.

AB - 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.

KW - Appendicitis

KW - Children's health care

KW - Disparity

KW - Pediatric surgery

KW - Surgical outcome

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SN - 0022-4804

VL - 249

SP - 42

EP - 49

JO - Journal of Surgical Research

JF - Journal of Surgical Research

ER -

Systematic Review of Disparities in Care and Outcomes in Pediatric Appendectomy

Abstract

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