title: Explaining insurance-related and racial disparities in the surgical management of patients with acute appendicitis.
abstract: 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.
authors.affiliation: 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
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Pieracci
authors.forename: Soumitra R
authors.initials: SR
authors.lastname: Eachempati
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christos
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
authors.forename: Alvin I
authors.initials: AI
authors.lastname: Mushlin
mesh_terms: 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