Racial Disparities; Appendectomy time


Other Public Health | Surgery


Racial and ethnic disparities in the rate of appendiceal rupture have been widely reported among the pediatric population. The main reasons for this remain largely unknown given that previous explanations pointing to signs of poor health care access have recently been shown to account for only a small percentage of the difference in perforation rates between white and minority children. Because the risk of perforation increases with time, racial disparities in time delay from emergency department presentation to OR appendectomy may help account for the higher appendiceal perforation rates observed among minority children. This is the first study dedicated to analyzing racial differences in door-to-appendectomy time. Insurance status and language barriers were also considered as variables of interest.

Retrospective, observational study using admission and treatment data of 607 consecutive children less than or equal to 18 years of age with surgical confirmation of appendicitis. Patients were admitted from February 2, 2013 (start of electronic medical record use) to April 27, 2017.

A significant association was found between race and perforation rate (p0.05 for all). Door-to-appendectomy times were also not significantly longer for Medicaid/uninsured patients (613 minutes) compared to private insurance patients (597 minutes) (p=0.60), nor for patients with language barriers (545 minutes) compared to patients without (612 minutes) (p=0.23).

While there was a higher appendiceal perforation rate among minority children, it was not due to differences in door-to-appendectomy time. Insurance status and language barriers also did not lead to differential treatment among pediatric patients.