Acute Appendicitis: Outcomes and Disparities based on Geographical Location and Race

Purpose Studies have shown better outcomes in pediatric patients with appendicitis managed by pediatric surgeons. There has been an increase rate in hospital-to-hospital transfer to divert pediatric patients to pediatric facilities. We looked to assess how initial presenting facility was associated with patient outcomes and assess how race impacts outcomes. Methods Pediatric patients managed at our Children’s Hospital from 2015-2021 with appendicitis were assessed. Retrospective analysis assessing rates of perforation, ionizing radiation use and readmission and hospital LOS were assessed and evaluated based on distance from the hospital and race. Results 240 patients transferred and 132 direct presentations were identified. We identified higher rates of perforation, 40.8% versus 27.2%, LOS of 3.56 versus 2.11 days, and higher rates of readmission, 7.3% versus 2.2% in those transferred versus direct presentation (p<0.05). Minorities that transferred had a higher LOS, 4.38 versus 2.57 days (p<0.05), compared to minorities who presented directly. Conclusions There are higher rates of perforation, readmission and LOS in those transferred than direct presentations. Transferring showed disproportionally worse outcomes in minority patients. This suggests distance from specialized pediatric care as well as patient race leads to worse outcomes and these variables have the potential to compound into poorer overall outcomes in minorities requiring transfer.