SAN DIEGO — White patients and those with private insurance are more likely to undergo laparoscopic surgery for appendicitis in New York state, according to results from a large analysis.
“In the case of race, this disparity is largely explained by the fact that minority patients tend to present to hospitals that perform fewer laparoscopic procedures for appendicitis,” Dr. Frederic M. Pieracci said at the annual meeting of the Surgical Infection Society.
However, this hospital clustering effect “does not fully explain differences in likelihood of laparoscopic surgery based on insurance status,” said Dr. Pieracci of the departments of surgery and public health at Weill Medical College of Cornell University in New York City.
The researchers chose to study race- and insurance-related patterns of appendectomy use “because appendicitis is common, because two surgical options exist, and though the clinical outcome is still debated, it is generally felt that the laparoscopic approach is more technologically advanced,” he explained. “Finally, utilization of laparoscopic appendectomy has increased markedly over the last 10 years.”
He and his associates analyzed the New York State Statewide Planning and Research Cooperative System (SPARCS) database to locate 26,104 patients who underwent appendectomy for acute appendicitis in 2003 and 2004. Required by state law, SPARCS contains data on all patients discharged from 207 nonfederal, acute care hospitals in New York. Of the 26,104 patients, 9,648 (37%) underwent laparoscopic appendectomy, while 16,456 (63%) underwent open appendectomy.
The mean age of patients was 39 years; 56% were male, 63% were white, and 59% had private insurance. Nearly three-quarters of laparoscopic appendectomies (72%) were performed at a teaching hospital.
After the researchers adjusted for age, gender, insurance status, hospital teaching status, and degree of appendicitis, they found that white patients were 24% more likely to undergo laparoscopic surgery than were nonwhite patients. But no significant difference was observed when the researchers controlled for a sixth variable: presenting to the hospital for laparoscopic appendectomy.
When Dr. Pieracci and his associates controlled for the same six variables in the insurance component of the analysis, they found that privately insured patients were 22% more likely to undergo laparoscopic appendectomy than were those without private insurance.
“The strengths of the study are that it includes recent data, it had nearly complete race information, and we [included] individual hospital use of laparoscopic appendectomy,” Dr. Pieracci said. “However, the study is limited in that it provides information for New York state only, it excluded pediatric patients, it did not account for patient comorbidities, and we were unable to capture conversion from laparoscopic to open,” he said.
White patients were 24% more likely to undergo laparoscopic surgery than were nonwhite patients. DR. PIERACCI