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Assessing surgical care delivery at facilities caring for higher volumes of minority children utilizing the pediatric quality indicator for perforated appendicitis: a propensity-matched analysis

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Abstract

Introduction

The pediatric quality indicator (PDI) measures released by the Agency for Healthcare Research and Quality (AHRQ) provide an impetus for benchmarking quality of care in children. The PDI-17, aimed at studying perforation in appendicitis, is one such measure that this study aims to utilize to assess surgical care delivery and outcomes in children managed at majority–minority hospitals.

Methods

The Kid Inpatient Database (2000–2012) was queried for pediatric patients (< 18 years) with a diagnosis of appendicitis, with and without perforation. Facilities were categorized into tertiles based on rates of perforation (PDI-17). Similarly, tertiles were generated based on volume of minority patients (Black and Hispanic) treated at each facility. Multivariable regression analysis adjusted for demographic parameters, hospital-level characteristics, propensity score quintiles, clinically relevant outcomes, and tertiles of minority patients treated.

Results

Of the 322,805 patients with appendicitis 28.7% had perforated appendicitis. Patients presenting to facilities caring for a higher volume of perforated appendicitis were younger with public insurance or no insurance and, however, these patients were less likely to belong to a minority group (p < 0.05). Additionally, these patients were less likely to belong to the highest income quartile (OR [95% CI] 0.45 [0.39–0.52]). Hospitals treating the highest volume of minority patients [majority–minority hospitals (MMHs)] had an 87% (OR [95% CI] 1.87 [1.77–1.98]) increased likelihood of also treating the highest rates of perforated appendicitis.

Conclusion

Hospitals treating a high volume of complicated appendicitis are less likely to care for minority groups. Additionally, MMHs lacking experience and volume in caring for complicated appendicitis have an increased likelihood of patients with perforations which is indicative of poor healthcare access.

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Authors and Affiliations

  1. Department of General and Thoracic Surgery, Children’s National Health System, Washington, DC, USA

    Adil A. Shah, Anthony Sandler, Timothy Kane & Mikael Petrosyan

  2. Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA

    Adil A. Shah, Wasay Nizam, Mallory Williams & Edward E. Cornwell III

  3. Department of Pediatrics, Children’s National Health System, Washington, DC, USA

    Paul Manicone

Authors
  1. Adil A. Shah
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  2. Wasay Nizam
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  3. Anthony Sandler
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  4. Timothy Kane
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  5. Paul Manicone
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  6. Mallory Williams
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  7. Edward E. Cornwell III
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  8. Mikael Petrosyan
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Correspondence to Adil A. Shah.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with human participants performed by any of the authors.

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The study utilized nationally available, de-identified patient data and informed consent was not necessary.

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Shah, A.A., Nizam, W., Sandler, A. et al. Assessing surgical care delivery at facilities caring for higher volumes of minority children utilizing the pediatric quality indicator for perforated appendicitis: a propensity-matched analysis. Pediatr Surg Int 36, 407–414 (2020). https://doi.org/10.1007/s00383-019-04604-z

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  • DOI: https://doi.org/10.1007/s00383-019-04604-z

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