O. Liu1, G. Giwa1, R. Gorijavolu1, C. Chidiac2, D. Rhee2 1Johns Hopkins University School Of Medicine, Baltimore, MD, USA 2Johns Hopkins University School Of Medicine, Department Of Surgery, Baltimore, MD, USA
Introduction: Studies show that race, ethnicity, and other socioeconomic inequities influence appendectomy outcomes for pediatric patients. Limited English Proficiency (LEP) has been posited as a barrier to coordination of healthcare, with disparities in health outcomes between fluent English speakers and LEP patients. The aim of the study is to determine whether there is an association between English proficiency and post-operative outcomes in pediatric patients undergoing appendectomy.
Methods: We analyzed records from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-P) database from 2010 to 2023 of patients, under 18 years of age, undergoing appendectomy at an academic tertiary care hospital. LEP was defined as the need for an interpreter. Primary outcomes were post-operative complications, length of stay, and post-operative ED visits within 30 days of discharge. Multivariate analyses were used to test the association of LEP with primary outcomes.
Results: 1,143 patients with appendicitis were included in the study, with 208 (18.20%) LEP and 935 (81.80%) English proficient (EP) patients. Compared to EP children, LEP children were more likely to present to the hospital with complicated appendicitis (42.79% vs 25.45%, p<.0001), sepsis (34.13% vs 21.60%, p=.0003), and high preoperative White Blood Cell (WBC) counts (mean WBC 16.52 vs 14.62, p<.0001). They were more likely to experience both serious (8.55% vs 3.85%, p=0.02) and overall complications (10.1% vs 5.45%, p=0.006). LEP patients had higher rates of post-operative interventions, such as PICC placement (9.62% vs 5.24%, p=0.04) and percutaneous drainage (8.17% vs 4.60%, p=0.01). On multivariate analysis controlling for ethnicity, age, and factors associated with complicated presentation, LEP was significantly associated with increased rate of post-operative ED visits (Odds Ratio [OR] 2.64, 95% Confidence Interval [CI] 1.40-4.39, p=.0009), but not significantly with length of stay (OR 1.86, 95% CI = 0.87-3.97, p=0.42) or complications (OR 1.76, 95% CI = 0.47-4.00, p=0.18).
Conclusion: In this cohort, there were important disparities in outcomes of pediatric appendectomies based on English proficiency. LEP is independently associated with higher risk of post-operative ED visits. Higher rates of complications and longer hospitalization in LEP patients may be related to increased rates of complicated appendicitis at presentation. The role of structural barriers, cultural preferences, and other social determinants of health that contribute to these disparities needs more investigation.
