County Versus Private Hospitals: Access of Care, Management and Outcomes for Patients with Appendicitis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Adult patients with appendicitis treated at a safety-net hospital were of lower socioeconomic background and had higher appendiceal perforation rates and longer lengths of hospitalization.

Abstract

Background and Objectives:

Race/ethnicity and socioeconomic status may affect healthcare access (higher appendiceal perforation [AP] rates), management (lower laparoscopic appendectomy [LA] rates), and outcomes in patients with appendicitis. This study determines if disparities exist between county and private hospitals.

Methods:

A review of patients ≥18 years treated for appendicitis from 1998 through 2007 was performed. Data from a county hospital were compared to data from 12 private hospitals. Study outcomes included length of hospitalization (LOH), and rates of AP, LA, and abscess drainage. Predictor variables collected included age, sex, race/ethnicity, per-capita income, and hospital type.

Results:

For this study, 16,512 patients were identified (county=1,293, private=15,219). On univariate analysis, patients at the county hospital had lower mean per-capita incomes ($13,412 vs. $17,584, P<.0001), similar AP rates at presentation (26% vs. 24%, P=.10), and lower abscess drainage (0.2% vs. 2.1%, P<.0001). However, multivariate analysis demonstrated a higher AP (OR 1.4, CI 1.2–1.6) and LA rate (OR 1.9, CI 1.7–2.2), a lower abscess drainage rate (0.07, 95%CI 0.02–0.27), and longer LOH (parameter estimate = 0.4, P<.0001) at the county hospital. Within the county hospital cohort, LOH and rates of AP, LA, and abscess drainage were similar across all races/ethnicities and income levels.

Conclusions:

When compared to private hospital patients, adults with appendicitis treated at a county hospital were of lower socioeconomic background, had higher AP rates and longer LOH, but were more likely to undergo LA and less likely to require abscess drainage. Since racial and socioeconomic disparities were no longer apparent once within the county hospital cohort, these differences may be due to differences in access to healthcare.

Related collections

Most cited references 14

Record: found
Abstract: found
Article: not found

Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children.

Robert Gilbert, Kory Kittle, F Brody … (2004)

The rates of appendiceal rupture and negative appendectomy in children remain high despite efforts to reduce them. Both outcomes are used as measures of hospital quality. Little is known about the factors that influence these rates. To investigate the association between hospital- and patient-level characteristics and the rates of appendiceal rupture and negative appendectomy in children. Retrospective review using the Pediatric Health Information System database containing information on 24,411 appendectomies performed on children aged 5 to 17 years at 36 pediatric hospitals in the United States between 1997 and 2002. Rates of negative appendectomy and appendiceal rupture; the odds ratio (OR) of negative appendectomy and appendiceal rupture by hospital, patient age, race, and health insurance status, and hospital fiscal year and appendectomy volume. Negative appendectomy rate was defined as the number of patients with appendectomy but without appendicitis divided by the total number of appendectomies. The median negative appendectomy rate was 3.06% (range, 1%-12%) and the median appendiceal rupture rate was 35.08% (range, 22%-62%). The adjusted OR for appendiceal rupture was higher in Asian children (1.66; 95% confidence interval [CI], 1.24-2.23) and black children (1.13; 95% CI, 1.01-1.30) compared with white children. Children without health insurance and children with public insurance had increased odds of appendiceal rupture compared with children who had private health insurance (adjusted OR, 1.36; 95% CI, 1.22-1.53 for self-insured; adjusted OR, 1.48; 95% CI, 1.34-1.64 for public insurance). No correlation existed between negative appendectomy rate and race, health insurance status, or hospital appendiceal rupture rate. The negative appendectomy rate improved as the hospital appendectomy volume increased. The rate of appendiceal rupture in school-aged children was associated with race and health insurance status and not with negative appendectomy rate and therefore is more likely to be associated with prehospitalization factors such as access to care, quality of care, and patient or physician education.

0 comments Cited 40 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Effects of race, insurance status, and hospital volume on perforated appendicitis in children.

Ken Kleinman, D Smink, Steven J. Fishman … (2005)

Previous research suggests that perforated appendicitis is more common in Medicaid patients, but the roles of minority race and hospital volume remain largely unstudied. We sought to investigate the association of perforated appendicitis in children with minority race, insurance status, and hospital volume. We conducted a retrospective, population-based cohort study of 33184 children who had an International Classification of Diseases, Ninth Revision diagnosis code for acute appendicitis in The Kids' Inpatient Database, a pediatric database from 22 states in 1997. A multivariate logistic regression model was developed to determine patient and hospital characteristics predictive of perforated appendicitis. Of 33184 children with acute appendicitis, 10777 (32.5%) were perforated. In multivariate analysis, black (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.10-1.39) and Hispanic (OR: 1.19; 95% CI: 1.10-1.29) children were more likely to have perforated appendicitis than white children. Perforation was also more likely in Medicaid patients (OR: 1.30; 95% CI 1.22-1.39) compared with privately insured children. Annual hospital volume of cases of appendicitis was not significantly associated with perforation in multivariate analysis. Perforated appendicitis disproportionately affected both children of minority race and children insured by Medicaid. No effect of hospital volume was observed. To reduce this racial disparity, efforts should focus on the causes of delayed diagnosis and the treatment of appendicitis in children of minority race.

0 comments Cited 28 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Insurance-related differences in the risk of ruptured appendix.

E V Schaaf, W Schecter, Brian Bennett … (1994)

We studied differences in the incidence of appendiceal perforation in patients with acute appendicitis according to their insurance coverage. In a retrospective analysis of hospital-discharge data, we examined the likelihood of ruptured appendix among adults 18 to 64 years old who were hospitalized for acute appendicitis in California from 1984 to 1989. After controlling for age, sex, psychiatric diagnoses, substance abuse, diabetes, poverty, race or ethnic group, and hospital characteristics, we found that ruptured appendix was more likely among both Medicaid-covered and uninsured patients with appendicitis than among patients with private capitated coverage (odds ratios, 1.49 [95 percent confidence interval, 1.41 to 1.59] and 1.46 [95 percent confidence interval, 1.39 to 1.54], respectively). After adjustment for the above factors, the risk of appendiceal rupture associated with a lack of private insurance was elevated at both county and other hospitals, but admission to a county hospital was an independent risk factor. In all income groups, appendiceal rupture was more likely with fee-for-service than capitated private coverage (overall odds ratio, 1.20 [95 percent confidence interval, 1.15 to 1.25]). Among patients with appendicitis an increased risk of ruptured appendix may be due to insurance-related delays in obtaining medical care. Both organizational and financial features of Medicaid and various types or levels of private third-party coverage may be involved. The significant association between ruptured appendix and insurance coverage after adjustment for socio-economic differences suggests barriers to receiving medically necessary acute care that should be considered in current deliberations on health policy.

0 comments Cited 27 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA

Department of Surgery, UCLA, Los Angeles, California, USA

Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA

Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.

Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Apr-Jun 2012

Volume: 16

Issue: 2

Pages: 283-286

Affiliations

Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA

Department of Surgery, UCLA, Los Angeles, California, USA

Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA

Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.

Author notes

Presented at the 20 ^th Society of Laparoendoscopic Surgeons Anniversary Meeting and Endo Expo 2011, Los Angeles, California, USA, September 14–17, 2011.

Address correspondence to: Steven L. Lee, MD, Division of Pediatric Surgery, Harbor-UCLA Medical Center, 1000 W Carson Street, Box 25, Torrance, CA, 90509, USA., Telephone: (310) 222-2706; Fax: (310) 782-1562, E-mail: slleemd@ 123456yahoo.com

Article

Publisher ID: 11-09-141

DOI: 10.4293/108680812X13427982376509

PMC ID: 3481221

SO-VID: 634de05c-5d89-4f59-98c7-d7dbb70dabe0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

County Versus Private Hospitals: Access of Care, Management and Outcomes for Patients with Appendicitis

Read this article at

Abstract

Abstract

Background and Objectives:

Methods:

Results:

Conclusions:

Related collections

25th European Students' Conference

Most cited references 14

Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children.

Effects of race, insurance status, and hospital volume on perforated appendicitis in children.

Insurance-related differences in the risk of ruptured appendix.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 39

Cited by 5

Most referenced authors 132