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News

Insurance status and race affects likelihood of laparoscopic appendectomy

In October's Journal of the American College of Surgeons, a report using secondary data finds that insurance status and race are marked independent predictors of having laporoscopic surgery in patients treated for appendicitis.

News image

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Previous studies have shown that racial and socioeconomic differences lead to inequality in access to health care.

However, until now it has been unknown whether insurance status and race affect the choice of surgical treatment for patients presenting with appendicitis.

Dr Guller's research team from Switzerland, selected patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy from the 1998, 1999, and 2000 Nationwide (US) Inpatient Samples.

Caucasian patients and Hispanics are more likely to have laparoscopic appendectomy, compared with African Americans

Journal of the American College of Surgeons

The group chose the primary predictor variables to be: insurance status (private, Medicare, Medicaid, other) and race (Caucasian, African American, Hispanic, other).

The research team used multiple logistic regression models to assess whether insurance status and race are associated with the choice of surgical procedure for patients presenting with appendicitis.

In total, 145,546 patients' discharge abstracts were used in the researchers' analyses.

There were 32,407 patients (22.3%) who underwent laparoscopic appendectomy and 113,139 patients (77.7%) who had open appendectomy.

The group found that although 24.2% of privately insured patients underwent laparoscopic appendectomy, only 16.9% of Medicare patients, 17.4% of Medicaid patients, and 19.6% of patients in the “other” insurance category were treated using the laparoscopic procedure.

In addition, the researchers found that caucasian patients underwent laparoscopic surgery in 24.8%, African Americans in 18.6%, Hispanics in 19.6%, and other ethnicities in 18.8% of patients (p < 0.001).

The group was able to reveal that privately insured patients and Medicare patients, compared with the Medicaid subset, after adjusting for potential confounders such as age, gender, race, patient comorbidity, median ZIP code income, hospital location and teaching status, and presence of abscess or perforation, were significantly more likely to undergo laparoscopic surgery.

Caucasian patients and Hispanics were found to be significantly more likely to have laparoscopic appendectomy, compared with African Americans, even after adjusting for the previously mentioned confounders and insurance status.

Dr Guller concluded, "Even after adjusting for potential confounders, insurance status and race are marked independent predictors of having laparoscopic surgery in patients treated for appendicitis in this sample".

Journal of the American College of Surgeons 2004: 199 (4): 567-575
01 October 2004

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