Explaining insurance-related and racial disparities in the surgical management of patients with acute appendicitis.
BACKGROUND
Race and insurance status influence the likelihood of undergoing laparoscopic appendectomy (LA) versus open appendectomy for the treatment of acute appendicitis. We hypothesized that these disparities are caused by presenting hospitals' use of LA.


METHODS
The analysis included 26,104 appendectomies for acute appendicitis in New York State during 2003 and 2004. Multiple logistic regression was used to determine independent predictors for undergoing LA versus open appendectomy.


RESULTS
Before adjustment for individual hospital use of LA, both white patients (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.21-1.36; P < .0001] and privately insured patients (OR = 1.52, 95% CI 1.44-1.61; P < .0001) were more likely to undergo LA. Controlling for differential hospitals' use of LA decreased the OR for laparoscopic surgery to 1.08 (95% CI 1.01-1.15; P = .04) for white patients and to 1.22 (95% CI 1.15-1.31; P < .0001) for privately insured patients.


CONCLUSIONS
Differences in presenting hospitals' use of LA maintain racial and, to a lesser extent, insurance-related disparities in the surgical management of patients with acute appendicitis.
Pieracci
Fredric M
FM
Department of Surgery, Weill Medical College of Cornell University, 411 East 69th St., No. KB-220, New York, NY 10021, USA. frp9005@med.cornell.edu
Eachempati
Soumitra R
SR
Christos
Paul J
PJ
Barie
Philip S
PS
Mushlin
Alvin I
AI
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011287:Prejudice