title: Perforation in adults with acute appendicitis linked to insurance status, not ethnicity.
abstract: BACKGROUND
  Delay in presentation is associated with increased perforation rates in acute appendicitis. Perforation is linked to greater morbidity, and greater risk of complications. The purpose of this study is to evaluate whether ethnicity or insurance status is associated with differences in presentation and outcomes in adult patients with acute appendicitis.
  
  
  METHODS
  A retrospective analysis was performed for all patients 18 y of age and over with acute appendicitis between July 1, 2005 and December 31, 2008 at the only teaching hospital in the region. χ(2) and regression analyses were used to evaluate the impact of ethnicity and insurance status on perforation rates.
  
  
  RESULTS
  A total of 1003 patients with acute appendicitis were identified, of which 239 (23.8%) were perforated. Those patients with public insurance were significantly more likely to have perforated disease (P < 0.001). Additionally, those patients in the older age groups (41-64 and ≥65) were also significantly more likely (P < 0.001) to have perforated appendicitis (35.8% and 38.24%, respectively, versus 19.2% for those 18-40). The patients who presented with perforation had a greater length of stay (2.71 ± 2.14 versus 6.04 ± 3.91 d, P < 0.001).
  
  
  CONCLUSIONS
  In our population sample, ethnicity does not predict perforation rates in adult patients with acute appendicitis. Significant risks of perforation appear related to insurance status and age.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Nevada School of Medicine, Las Vegas, Nevada 89102, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Boomer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Freeman
authors.forename: Earl
authors.initials: E
authors.lastname: Landrito
authors.forename: Alexander
authors.initials: A
authors.lastname: Feliz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001064:Appendicitis / Q000453:epidemiology* / Q000208:ethnology*; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies