Gerk Ayla, Moreira Melo Paulo Henrique, Amoei Mohsen, Kundu Shreenik, Telles Luiza, Seyi-Olajide Justina O, Moghul Dunya, Schnitman Gabriel, Camargo Cristina, Mooney David P, Bustorff-Silva Joaquim, Poenaru Dan
Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
Harvey E. Beardmore Division of Pediatric Surgery, Harvey E. Beardmore Department of Surgery, The Montreal Children's Hospital, McGill University Health Centre, 5252 Boul de Maisonneuve Ouest, Montréal, QC, H4 A 3S5, Canada.
Pediatr Surg Int. 2025 May 20;41(1):141. doi: 10.1007/s00383-025-06030-w.
Appendicitis is the most prevalent surgical emergency in children. This study explores the social and clinical determinants affecting the surgical approach for pediatric appendectomy in Brazil.
All patients aged 0-16 years hospitalized and operated on for acute appendicitis in Brazil during 2022 were identified in the Brazilian national healthcare database. Data reviewed included patient demographics, hospital resources and location. Univariable and multivariable logistic regression models were used for statistical analysis.
We identified 24,088 patients, of which 8768 (36.4%) were female, with a mean age of 10 years. 9690 (40.2%) of patients were white and 14.398 (59.8%) were non-white (including brown, black, asian or indigenous). Geographically, more patients were from the Southeast region. 21,627 (89.8%) of cases were open appendectomies. On univariable analysis, factors significantly influencing the selection of laparoscopic appendectomy included being female, white race, and higher socioeconomic status. The severity of appendicitis did not significantly affect the surgical approach. On multivariable analysis, white race (OR 1.934, [1.759, 2.126]), advanced hospital facilities (OR 5.987, [5.395, 6.644]), and hospitals located in the wealthier Southern region (OR 4.277, [3.884, 4.710]) were significant predictors of a laparoscopic approach.
The surgical approach for pediatric appendectomy in Brazil was determined by social determinants rather than by disease severity. The findings emphasize the need for targeted interventions to ensure equitable healthcare access and approaches in pediatric surgery.
阑尾炎是儿童中最常见的外科急症。本研究探讨了影响巴西小儿阑尾炎手术方式的社会和临床决定因素。
在巴西国家医疗数据库中识别出2022年期间在巴西住院并接受急性阑尾炎手术的所有0至16岁患者。审查的数据包括患者人口统计学、医院资源和位置。使用单变量和多变量逻辑回归模型进行统计分析。
我们识别出24,088名患者，其中8768名（36.4%）为女性，平均年龄为10岁。9690名（40.2%）患者为白人，14,398名（59.8%）为非白人（包括棕色人种、黑人、亚洲人或原住民）。在地理上，更多患者来自东南部地区。21,627例（89.8%）为开腹阑尾切除术。单变量分析显示，显著影响腹腔镜阑尾切除术选择的因素包括女性、白人种族和较高的社会经济地位。阑尾炎的严重程度对手术方式没有显著影响。多变量分析显示，白人种族（比值比1.934，[1.759, 2.126]）、先进的医院设施（比值比5.987，[5.395, 6.644]）以及位于较富裕的南部地区的医院（比值比4.277，[3.884, 4.710]）是腹腔镜手术方式的显著预测因素。
巴西小儿阑尾炎的手术方式由社会决定因素而非疾病严重程度决定。研究结果强调需要有针对性的干预措施，以确保小儿外科手术中公平的医疗服务可及性和手术方式。
