Pieracci Fredric M, Eachempati Soumitra R, Christos Paul J, Barie Philip S, Mushlin Alvin I
Department of Surgery, Weill Medical College of Cornell University, 411 East 69th St., No. KB-220, New York, NY 10021, USA.
Am J Surg. 2007 Jul;194(1):57-62. doi: 10.1016/j.amjsurg.2006.11.024.
Race and insurance status influence the likelihood of undergoing laparoscopic appendectomy (LA) versus open appendectomy for the treatment of acute appendicitis. We hypothesized that these disparities are caused by presenting hospitals' use of LA.
The analysis included 26,104 appendectomies for acute appendicitis in New York State during 2003 and 2004. Multiple logistic regression was used to determine independent predictors for undergoing LA versus open appendectomy.
Before adjustment for individual hospital use of LA, both white patients (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.21-1.36; P < .0001] and privately insured patients (OR = 1.52, 95% CI 1.44-1.61; P < .0001) were more likely to undergo LA. Controlling for differential hospitals' use of LA decreased the OR for laparoscopic surgery to 1.08 (95% CI 1.01-1.15; P = .04) for white patients and to 1.22 (95% CI 1.15-1.31; P < .0001) for privately insured patients.
Differences in presenting hospitals' use of LA maintain racial and, to a lesser extent, insurance-related disparities in the surgical management of patients with acute appendicitis.
种族和保险状况会影响因急性阑尾炎接受腹腔镜阑尾切除术（LA）而非开腹阑尾切除术的可能性。我们推测这些差异是由就诊医院对LA的使用情况导致的。
该分析纳入了2003年至2004年纽约州26,104例急性阑尾炎阑尾切除术。采用多因素逻辑回归确定接受LA与开腹阑尾切除术的独立预测因素。
在对各医院LA使用情况进行调整之前，白人患者（优势比[OR]=1.28，95%置信区间[CI]1.21 - 1.36；P<.0001）和私人保险患者（OR = 1.52，95% CI 1.44 - 1.61；P<.0001）接受LA的可能性更高。控制不同医院对LA的使用情况后，白人患者接受腹腔镜手术的OR降至1.08（95% CI 1.01 - 1.15；P = .04），私人保险患者的OR降至1.22（95% CI 1.15 - 1.31；P<.0001）。
就诊医院对LA使用情况的差异在急性阑尾炎患者手术治疗中维持了种族差异，并在较小程度上维持了与保险相关的差异。
