Geographic & Socioeconomic Predictors of Perforated Appendicitis: A National Canadian Cohort Study Gilly Akhtar-Danesh, Aristithes Doumouras, Dennis Hong, Helene Flageole
Disclosure No conflicts of interest to declare
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
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
Objective To determine whether geography and socioeconomic status predict perforated appendicitis in children within a large, universal healthcare system.
Methods Population-based retrospective cohort Canadian children with appendicitis from 2008 2015 Outcomes Perforation rates Complications
Methods Predictors Patient factors Surgeon and hospital specialization SES Distance from treating hospital Spatial analysis identified neighbourhoods with average vs. high perforation rates
Results 43,055 children with appendicitis identified Overall perforation rate 31.5% Higher perforation rates Females Younger children Rural neighbourhoods & >125 km distance
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
Results
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
Discussion In single-payer system, SES does not affect outcomes Studies across cancer and surgical care However, rurality influences access to care in adults
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
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
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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