Department of Surgery, St. Luke's Hospital of Kansas City, Kansas City, MO 64108.
Department of Surgery, Orlando Health Medical Center, Orlando, FL 32806.
J Pediatr Surg. 2021 Apr;56(4):663-667. doi: 10.1016/j.jpedsurg.2020.10.003. Epub 2020 Oct 18.
Previous reports in the literature demonstrate racial and ethnic disparities for children diagnosed with acute appendicitis, with minorities experiencing worse outcomes. At our institution, we have developed an evidence based patient driven protocol for children following laparoscopic appendectomy. However, the influence of such protocol on mitigating racial and ethnic disparities in outcomes remains unknown. The purpose of our study is to assess the impact of our protocol by evaluating the influence of race and ethnicity on surgical outcomes among children treated for acute appendicitis.
A retrospective review of prospectively collected data was conducted. Children undergoing a laparoscopic appendectomy at our freestanding children's hospital between December 2015 and July 2017 were included. Demographic data, post-operative length of stay, same day discharge rates and hospital readmission rates were abstracted from patient medical records. Patients were classified by their race and ethnic background. Comparative analysis was performed in STATA with a p value <.05 determined as significant.
A total of 786 children were included, with the majority being either White (70%, n = 547), Black (8%, n = 62) or Hispanic (17%, n = 133); 569 patients (72%) were found to have non-perforated appendicitis. There was no statistically significant difference in the rates of same day discharge among White, Black or Hispanic children respectively (88% vs. 77% vs. 86%, p = .126). Of the 217 children with perforated appendicitis, Hispanic children had increased rates of perforation (41%, n = 55) compared to White and Black children respectively (23%, n = 128 and 29%, n = 18, p = .001). However, average post-operative length of stay were similar among White, Black and Hispanic children (96 h vs. 95 h vs. 98 h, p = .015). On multivariate analysis, the only significant risk factor for an elevated post-operative length of stay was the presence of a perforation.
Our evidence based patient driven protocol effectively mitigates racial and ethnic disparities found in children with acute appendicitis. Further prospective investigation into the role of such patient-driven protocols to mitigate healthcare disparities is warranted.
Therapeutic study; Level 3.
文献中的先前报告表明，患有急性阑尾炎的儿童存在种族和民族差异，少数民族的预后更差。在我们的机构，我们为腹腔镜阑尾切除术后的儿童制定了循证的患者驱动方案。然而，这种方案对减轻结果中的种族和民族差异的影响尚不清楚。我们研究的目的是通过评估种族和民族对接受急性阑尾炎治疗的儿童的手术结果的影响来评估我们方案的影响。
对前瞻性收集的数据进行回顾性审查。2015 年 12 月至 2017 年 7 月期间，在我们的独立儿童医院行腹腔镜阑尾切除术的儿童被纳入研究。从患者病历中提取人口统计学数据、术后住院时间、当日出院率和医院再入院率。根据种族和民族背景对患者进行分类。使用 STATA 进行比较分析，p 值<.05 被认为具有统计学意义。
共纳入 786 名儿童，其中大多数为白人（70%，n=547）、黑人（8%，n=62）或西班牙裔（17%，n=133）；569 名患者（72%）患有非穿孔性阑尾炎。白人、黑人或西班牙裔儿童的当日出院率无统计学差异（分别为 88%、77%和 86%，p=0.126）。在 217 例穿孔性阑尾炎患儿中，西班牙裔患儿穿孔率增加（41%，n=55），而白人患儿和黑人患儿穿孔率分别为（23%，n=128）和（29%，n=18，p=0.001）。然而，白人、黑人及西班牙裔儿童术后平均住院时间相似（96 小时比 95 小时比 98 小时，p=0.015）。多因素分析显示，术后住院时间延长的唯一显著危险因素是穿孔的存在。
我们的循证的患者驱动方案有效地减轻了急性阑尾炎患儿中存在的种族和民族差异。进一步前瞻性研究这种患者驱动方案减轻医疗保健差异的作用是必要的。
治疗研究；等级 3。
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