J. G. Ulugia1, T. L. Duncan1, E. R. Scaife1, B. T. Bucher1 1University Of Utah,Division Of Pediatric Surgery, Department Of Surgery,Salt Lake City, UT, USA
Introduction: We sought to assess the impact of race and ethnicity, among other factors, on post-discharge hospital resource utilization following the treatment of acute appendicitis in children.
Methods: We performed a retrospective cohort study of 45 Children’s Hospitals from 2010-2015. Patients were included if they were diagnosed with acute appendicitis based on International Classification of Diseases, 9th edition, and were 18 years of age or less during the study timeframe. Patients were excluded if they expired during the encounter. The primary predictor was patient defined race and ethnicity, and grouped into non-Hispanic white (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HL) or other. The primary outcome was 30-day post-discharge emergency department (ED) visit or inpatient readmission. Baseline characteristic differences were adjusted to account for disease severity including perforated appendicitis, procedure type, length of stay, and insurance type. The association of race and ethnicity on the primary outcome was assessed using univariate and multivariate logistic regression models computed in R (Version 3.4.0).
Results: Overall, 80,913 patients were identified as meeting inclusion criteria. The median age of our cohort was 11 years (IQR 8-13 years) and 60.3% of them were male. The majority (49.8%) of patients were NHW, 7.1% were NHB, and 32.4% HL. The rate of perforated appendicitis in our cohort was 13.3%, and 92% of children underwent a laparoscopic appendectomy. The overall rate of an ED visit within 30 days of discharge was 5.1%, and the overall rate of inpatient readmission within 30 days post-discharge was 3.9%. Compared to NHW, both NHB (p<0.0001) and HL (p<0.0001) children had a significantly increased rate of 30-day post-discharge ED visits (Table). However, there was not a corresponding increase in 30-day inpatient readmission in NHB (p=0.13) and HL (p=0.13) children compared to NHW. After adjusting for differences in baseline characteristics and disease severity, NHB and HL children had a significantly increased risk of 30-day ED visits. However, there was not a significantly increased risk of inpatient readmission in NHB and HL children (Table).
Conclusion: Compared to NHW children, NHB and HL children treated for appendicitis at US Children’s Hospitals are at a significantly increased risk of returning to the ED within 30 days post-discharge, without a corresponding increase in risk of inpatient readmission. This data suggests a racial and ethnic disparity in post-discharge care of children with appendicitis, and the preferential use of the ED for post-operative follow-up care in NHB and HL children.?
