Geographic & Socioeconomic Predictors of Perforated Appendicitis: A National Canadian Cohort Study

Transcription

1 Geographic & Socioeconomic Predictors of Perforated Appendicitis: A National Canadian Cohort Study Gilly Akhtar-Danesh, Aristithes Doumouras, Dennis Hong, Helene Flageole

2 Disclosure No conflicts of interest to declare

3 Background Appendicitis is the most common surgical emergency in children Outcomes are dependent on disease severity Perforated appendicitis associated with Increased morbidity Longer length of stay

4 Background Some studies suggest SES predicts perforation rates Effect should dissipate in a universal healthcare system Rurality increases perforation risk in adults Exact spatial patterns have not been delineated

5 Objective To determine whether geography and socioeconomic status predict perforated appendicitis in children within a large, universal healthcare system.

6 Methods Population-based retrospective cohort Canadian children with appendicitis from Outcomes Perforation rates Complications

7 Methods Predictors Patient factors Surgeon and hospital specialization SES Distance from treating hospital Spatial analysis identified neighbourhoods with average vs. high perforation rates

8 Results 43,055 children with appendicitis identified Overall perforation rate 31.5% Higher perforation rates Females Younger children Rural neighbourhoods & >125 km distance

9 Results SES not associated with perforation risk >750,000 children living in high perforation clusters Complication rates associated with Use of laparoscopy Perforation Treatment at a pediatric hospital

10 Results

11 Discussion Understanding the determinants of surgical outcomes is imperative to improving outcomes In the multi-payer healthcare system, access affected by Race SES Insurance status Education

12 Discussion In single-payer system, SES does not affect outcomes Studies across cancer and surgical care However, rurality influences access to care in adults

13 Discussion This study found a clear inequity in outcomes based solely on patient location Independent of other factors >750,000 Canadian children at increased risk of complications from appendicitis No benefit offered by treatment at a pediatric hospital

14 Conclusion SES has no impact on appendiceal perforation rates in a universal healthcare system Geography is an important determinant of outcomes Despite universal healthcare, inequities exist in access to timely surgical care

15 Conclusion In a universal healthcare system, appendiceal perforation is a spatial phenomenon Distance from treating hospital and rurality increase perforation risk Disparities exist in access to timely surgical care in large countries with universal healthcare systems

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