Explaining insurance-related and racial disparities in the surgical management of patients with acute appendicitis

Pieracci, Fredric M.; Eachempati, Soumitra R.; Christos, Paul J.; Barie, Philip S.; Mushlin, Alvin I.

doi:10.1016/j.amjsurg.2006.11.024

« Previous Next »The American Journal of Surgery
Volume 194, Issue 1 , Pages 57-62, July 2007

Explaining insurance-related and racial disparities in the surgical management of patients with acute appendicitis

Fredric M. Pieracci, M.D., M.P.H.
- Department of Surgery, Weill Medical College of Cornell University, 411 East 69th St., No. KB-220, New York, NY 10021, USA
- Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA
- Corresponding author. Tel.: +1-212-746-1205; fax: +1-212-746-8544.
Soumitra R. Eachempati, M.D.
- Department of Surgery, Weill Medical College of Cornell University, 411 East 69th St., No. KB-220, New York, NY 10021, USA
- Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA
Paul J. Christos, M.S., M.P.H.
- Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA
Philip S. Barie, M.D., M.B.A.
- Department of Surgery, Weill Medical College of Cornell University, 411 East 69th St., No. KB-220, New York, NY 10021, USA
- Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA
Alvin I. Mushlin, M.D., Sc.M.
- Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA

Received 28 July 2006; received in revised form 14 November 2006

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.

Keywords: Access to health care, Appendicitis, Insurance, Laparoscopy, Outcomes, Socioeconomic factors