J. H. Scaife2, S. E. Iantorno1, M. Yang1, B. T. Bucher1 1University Of Utah, Department Of Surgery, Salt Lake City, UT, USA 2University Of Utah, School Of Medicine, Salt Lake City, UT, USA
Introduction:
Surgical outcomes are influenced by patient-level demographic data, but little is known about the influence of neighborhood social determinants of health (SDOH) factors. We sought to determine how the SDOH factors outlined in the 2020 Childhood Opportunity Index (COI) affected the rate of 30-day readmission following an appendectomy in pediatric patients.
Methods:
We conducted a retrospective cohort study using the 2019 State Inpatient Databases for California, Florida, and New York. Eligible patients were under 18 with a primary procedure of appendectomy identified by International Classification of Disease 10th Edition procedure codes. Patients with a diagnosis of perforated appendicitis were excluded. The primary outcomes were 1) inpatient readmission or 2) an ED visit to any facility within 30 days of hospital discharge. We used the 2019 ZIP code level COI to determine neighborhood SDOH factors. We developed generalized linear logistic regression models to assess the association between rates of readmission and patient demographics, including neighborhood SDOH.
Results:
Our analysis included 17,577 patients, with 46% from California, 26% from Florida, and 28% from New York. 795 patients (4.5%) presented with complaints within 30 days; 1.7% had inpatient readmission, and 3.1% had presented to an ED. 2,733 (16%) patients received care from children’s hospitals. The multivariable odds of either inpatient readmission or ED presentation were significantly lower for patients presenting to children’s hospitals (aOR [95%CI]: 0.6, [0.47-0.75]). The odds were higher for Black (aOR [95%CI]: 1.7, [1.27-2.26]), Hispanic (aOR [95%CI]: 1.28, [1.07-1.53]), and Asian/Pacific Islander patients (aOR [95%CI]: 1.59, [1.07-2.28]) compared to white patients; patients younger than 6 (aOR [95%CI]: 2.22, [1.71-2.85]) in comparison to 12-17-year-olds; patients from ZIP codes with “Very Low” childhood opportunity (aOR [95%CI]: 1.62 [1.18-2.27]) compared to patients with “Very High.” There was no significant association between COI and the odds of inpatient readmission. However, the odds of ED presentation are significantly higher in children from “Very Low” COI neighborhoods compared to “Very High”. (Table)
Conclusion:
The odds of being readmitted are lower for patients who received an appendectomy from a Children’s hospital and higher for racial/ethnic minority patients. Patients from low COI ZIP codes are more likely to present to an ED in the thirty days following an appendectomy but do not have an increased risk of readmission. These findings suggest that children from areas with worse socioeconomic factors are utilizing the ED for outpatient care following an appendectomy.
