title: Predictors of appendiceal perforation in an equal access system.
abstract: BACKGROUND
  Discrepancies in socioeconomic factors have been associated with higher rates of perforated appendicitis. As an equal-access health care system theoretically removes these barriers, we aimed to determine if remaining differences in demographics, education, and pay result in disparate outcomes in the rate of perforated appendicitis.
  
  
  METHODS
  All patients undergoing appendectomy for acute appendicitis (November 2004-October 2009) at a tertiary care equal access institution were categorized by demographics and perioperative data. Rank of the sponsor was used as a surrogate for economic status. A multivariate logistic regression model was performed to determine patient and clinical characteristics associated with perforated appendicitis.
  
  
  RESULTS
  A total of 680 patients (mean age 30±16 y; 37% female) were included. The majority were Caucasian (56.4% [n=384]; African Americans 5.6% [n=38]; Asians 1.9% [n=13]; and other 48.9% [n=245]) and enlisted (87.2%). Overall, 6.4% presented with perforation, with rates of 6.6%, 5.8%, and 6.7% (P=0.96) for officers, enlisted soldiers, and contractors, respectively. There was no difference in perforation when stratified by junior or senior status for either officers or enlisted (9.3% junior versus 4.40% senior officers, P=0.273; 6.60% junior versus 5.50% senior enlisted, P=0.369). On multivariate analysis, parameters such as leukocytosis and temperature, as well as race and rank were not associated with perforation (P=0.7). Only age had a correlation, with individuals aged 66-75 y having higher perforation rates (odds ratio, 1.04; 95% confidence interval, 1.02-1.05; P<0.001).
  
  
  CONCLUSIONS
  In an equal-access health care system, older age, not socioeconomic factors, correlated with increased appendiceal perforation rates.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.
authors.forename: Avery
authors.initials: A
authors.lastname: Walker
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.
authors.forename: Quinton
authors.initials: Q
authors.lastname: Hatch
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Thurston
authors.initials: T
authors.lastname: Drake
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Nelson
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.
authors.forename: Emilie
authors.initials: E
authors.lastname: Fitzpatrick
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.
authors.forename: Jason
authors.initials: J
authors.lastname: Bingham
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.
authors.forename: George
authors.initials: G
authors.lastname: Black
authors.affiliation: Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington. Electronic address: averyw21@gmail.com.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001064:Appendicitis / Q000453:epidemiology* / Q000208:ethnology / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
keywords: Appendectomy; Appendicitis; Race; Rank; Socioeconomic status