Insurance Status, but Not Race, Predicts Perforation in Adult Patients with Acute Appendicitis

Pieracci, Fredric M.; Eachempati, Soumitra R.; Barie, Philip S.; Callahan, Mark A.

doi:10.1016/j.jamcollsurg.2007.04.010

« Previous Next »Journal of the American College of Surgeons
Volume 205, Issue 3 , Pages 445-452, September 2007

Insurance Status, but Not Race, Predicts Perforation in Adult Patients with Acute Appendicitis

Fredric M. Pieracci, MD, MPH
- Department of Surgery, Weill Medical College of Cornell University, New York, NY.
- Department of Public Health, Weill Medical College of Cornell University, New York, NY.
- Correspondence address: Fredric M Pieracci, MD, 411 East 69^th St, #KB-220, New York, NY 10021.
Soumitra R. Eachempati, MD, FACS
- Department of Surgery, Weill Medical College of Cornell University, New York, NY.
- Department of Public Health, Weill Medical College of Cornell University, New York, NY.
Philip S. Barie, MD, MBA, FACS
- Department of Surgery, Weill Medical College of Cornell University, New York, NY.
- Department of Public Health, Weill Medical College of Cornell University, New York, NY.
Mark A. Callahan, MD
- Department of Surgery, Weill Medical College of Cornell University, New York, NY.

Received 18 October 2006; received in revised form 28 March 2007; accepted 9 April 2007. published online 26 June 2007.

Background

Delay in treatment is a strong risk factor for perforation during acute appendicitis. In addition, lower socioeconomic status has been linked to impaired access to surgical care. We sought to examine the relationships among race, insurance status, and perforation in a recent, adult population with acute appendicitis.

Study Design

Data on adult patients with acute appendicitis were abstracted from the New York State Statewide Planning and Cooperative Systems Database for the years 2003 and 2004. A multiple logistic regression model, which adjusted for patient, community, and hospital factors, was used to examine the independent effects of both race and insurance status on likelihood of perforation.

Results

A total of 29,637 patients had acute appendicitis; 7,969 (26.9%) of these were perforated. Although Caucasian patients were more likely to perforate compared with minority patients, by univariate analysis, adjustment for age alone eliminated this disparity. In addition, by multivariable analysis, no difference existed in odds of perforation for Caucasian patients compared with African-American (odds ratio [OR]=1.03, 95% CI [0.93, 1.15], p=0.52), Hispanic (OR=0.99, 95% CI [0.90, 1.08], p=0.82), or Asian patients (OR=0.85, 95% CI [0.73, 1.00], p=0.05). But compared with privately insured patients, uninsured patients (OR 1.18, 95% CI [1.07 to 1.30], p=0.0005), Medicaid patients (OR=1.22, 95% CI [1.12 to 1.33], p < 0.0001), and Medicare patients (OR=1.14, 95% CI [1.03, 1.25], p=0.01) were significantly more likely to have perforation.

Conclusions

Race does not appear to be an important variable in predicting perforation in adult patients with acute appendicitis, but the likelihood of perforation varies significantly according to insurance status. Future research is necessary to both understand and have an impact on this socioeconomic disparity.