title: Are there differences in access to care, treatment, and outcomes for children with appendicitis treated at county versus private hospitals?
abstract: BACKGROUND
  We conducted a study to determine whether hospital type (county [ie, safety-net] vs private) affects health care access (appendiceal perforation [AP] rates), treatment (laparoscopic appendectomy [LA] rates), and outcomes in children with appendicitis.
  
  
  METHODS
  A review of cases involving children who had appendicitis between 1998 and 2007 was performed. Data from county and private hospitals were compared. Outcomes were AP rates, LA rates, need for postoperative abscess drainage, length of hospitalization (LOH), and cost.
  
  
  RESULTS
  Multivariate analysis confirmed that among 7902 patients, (county = 682; private = 7220), county-hospital patients had lower incomes, higher AP rates, higher LA rates, lower postoperative abscess drainage rates, and longer LOH than did private-hospital patients. The longer LOH at the county institution led to higher costs. Within the county hospital, outcomes were similar across all ethnic groups and income levels.
  
  
  CONCLUSIONS
  Children with appendicitis treated at a county hospital were of lower socioeconomic background and had higher AP rates, longer LOH, and higher costs than their counterparts at private hospitals, but were more likely to undergo LA and require less abscess drainage. Within the county hospital, ethnic and socioeconomic disparities were not apparent; thus, these differences between institutions might have been caused by underlying disparities in ethnicity, income, and health care access.
authors.affiliation: Harbor-UCLA Medical Center, Torrence, CA, USA. slleemd@yahoo.com
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lee
authors.forename: Arezou
authors.initials: A
authors.lastname: Yaghoubian
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stark
authors.forename: Roman M
authors.initials: RM
authors.lastname: Sydorak
authors.forename: Amy
authors.initials: A
authors.lastname: Kaji
mesh_terms: D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006766:Hospitals, County / Q000592:standards* / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome