County Versus Private Hospitals: Access of Care, Management and Outcomes for Patients with Appendicitis

BACKGROUND AND OBJECTIVES: Race/ethnicity and socioeconomic status may affect healthcare access (higher appendiceal perforation [AP] rates), management (lower laparoscopic appendectomy [LA] rates), and outcomes in patients with appendicitis. This study determines if disparities exist between county and private hospitals. METHODS: A review of patients ≥18 years treated for appendicitis from 1998 through 2007 was performed. Data from a county hospital were compared to data from 12 private hospitals. Study outcomes included length of hospitalization (LOH), and rates of AP, LA, and abscess drainage. Predictor variables collected included age, sex, race/ethnicity, per-capita income, and hospital type. RESULTS: For this study, 16,512 patients were identified (county=1,293, private=15,219). On univariate analysis, patients at the county hospital had lower mean per-capita incomes ($13,412 vs. $17,584, P<.0001), similar AP rates at presentation (26% vs. 24%, P=.10), and lower abscess drainage (0.2% vs. 2.1%, P<.0001). However, multivariate analysis demonstrated a higher AP (OR 1.4, CI 1.2–1.6) and LA rate (OR 1.9, CI 1.7–2.2), a lower abscess drainage rate (0.07, 95%CI 0.02–0.27), and longer LOH (parameter estimate = 0.4, P<.0001) at the county hospital. Within the county hospital cohort, LOH and rates of AP, LA, and abscess drainage were similar across all races/ethnicities and income levels. CONCLUSIONS: When compared to private hospital patients, adults with appendicitis treated at a county hospital were of lower socioeconomic background, had higher AP rates and longer LOH, but were more likely to undergo LA and less likely to require abscess drainage. Since racial and socioeconomic disparities were no longer apparent once within the county hospital cohort, these differences may be due to differences in access to healthcare.