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Insurance status and race represent independent predictors of undergoing laparoscopic surgery for appendicitis: secondary data analysis of 145,546 patients.

Publication ,  Journal Article
Guller, U; Jain, N; Curtis, LH; Oertli, D; Heberer, M; Pietrobon, R
Published in: J Am Coll Surg
October 2004

BACKGROUND: Studies have shown that racial and socioeconomic differences lead to inequality in access to health care. It is unknown whether insurance status and race affect the choice of surgical treatment for patients presenting with appendicitis. STUDY DESIGN: Patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy were selected from the 1998, 1999, and 2000 Nationwide (US) Inpatient Samples. The primary predictor variables were insurance status (private, Medicare, Medicaid, other) and race (Caucasian, African American, Hispanic, other). Multiple logistic regression models were used to assess whether insurance status and race are associated with the choice of surgical procedure for patients presenting with appendicitis. RESULTS: Discharge abstracts of 145,546 patients were used for our analyses. There were 32,407 patients (22.3%) who underwent laparoscopic appendectomy and 113,139 patients (77.7%) who had open appendectomy. 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 (p < 0.001). 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). Compared with the Medicaid subset, and 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, privately insured patients (odds ratio [OR] = 1.26, 95% [CI [1.20, 1.33], p < 0.001) and Medicare patients (OR = 1.17, 95% CI [1.05, 1.30], p = 0.004) were significantly more likely to undergo laparoscopic surgery. Caucasian patients (OR = 1.42, 95% CI [1.33, 1.51], p < 0.001) and Hispanics (OR = 1.12, 95% CI [1.04, 1.20], p = 0.002) were significantly more likely to have laparoscopic appendectomy, compared with African Americans, even after adjusting for the previously mentioned confounders and insurance status. CONCLUSIONS: 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.

Duke Scholars

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

October 2004

Volume

199

Issue

4

Start / End Page

567 / 575

Location

United States

Related Subject Headings

  • United States
  • Surgery
  • Socioeconomic Factors
  • Racial Groups
  • Male
  • Laparoscopy
  • Insurance, Health
  • Insurance Coverage
  • Humans
  • Health Services Accessibility
 

Citation

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ICMJE
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Guller, U., Jain, N., Curtis, L. H., Oertli, D., Heberer, M., & Pietrobon, R. (2004). Insurance status and race represent independent predictors of undergoing laparoscopic surgery for appendicitis: secondary data analysis of 145,546 patients. J Am Coll Surg, 199(4), 567–575. https://doi.org/10.1016/j.jamcollsurg.2004.06.023
Guller, Ulrich, Nitin Jain, Lesley H. Curtis, Daniel Oertli, Michael Heberer, and Ricardo Pietrobon. “Insurance status and race represent independent predictors of undergoing laparoscopic surgery for appendicitis: secondary data analysis of 145,546 patients.J Am Coll Surg 199, no. 4 (October 2004): 567–75. https://doi.org/10.1016/j.jamcollsurg.2004.06.023.
Guller U, Jain N, Curtis LH, Oertli D, Heberer M, Pietrobon R. Insurance status and race represent independent predictors of undergoing laparoscopic surgery for appendicitis: secondary data analysis of 145,546 patients. J Am Coll Surg. 2004 Oct;199(4):567–75.
Guller, Ulrich, et al. “Insurance status and race represent independent predictors of undergoing laparoscopic surgery for appendicitis: secondary data analysis of 145,546 patients.J Am Coll Surg, vol. 199, no. 4, Oct. 2004, pp. 567–75. Pubmed, doi:10.1016/j.jamcollsurg.2004.06.023.
Guller U, Jain N, Curtis LH, Oertli D, Heberer M, Pietrobon R. Insurance status and race represent independent predictors of undergoing laparoscopic surgery for appendicitis: secondary data analysis of 145,546 patients. J Am Coll Surg. 2004 Oct;199(4):567–575.
Journal cover image

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

October 2004

Volume

199

Issue

4

Start / End Page

567 / 575

Location

United States

Related Subject Headings

  • United States
  • Surgery
  • Socioeconomic Factors
  • Racial Groups
  • Male
  • Laparoscopy
  • Insurance, Health
  • Insurance Coverage
  • Humans
  • Health Services Accessibility