Diagnosis of delayed appendicitis more frequent in non-Hispanic Black adults: JAMA

USA: A recent study published in JAMA Surgery has found an increased rate of delayed appendicitis diagnosis among non-Hispanic Black patients than White patients, putting them at a higher perforated appendicitis and subsequent post-surgical infections.

The Northwestern Medicine study further showed that the delay in diagnosis was less common for patients cared for in hospitals serving greater than 50% Black-Hispanic populations compared to hospitals serving less than 25% Black-Hispanic populations.

The study also found nearly half the cohort with the delayed diagnosis was ultimately diagnosed and treated with surgery for their appendicitis at a different hospital from the first one that failed to diagnose appendicitis.

This is the first study to show racial-ethnic disparities in the delay of diagnosis of appendicitis in adults. It also is the first to find that hospitals serving more minority patient populations are less likely to delay diagnosis of appendicitis than hospitals serving fewer minority patient populations.

The retrospective observational study was based on data from 80,312 patients, aged 18 to 64, who underwent appendectomy from 2016 to 2017 in Florida, Maryland, New York and Wisconsin.

Appendicitis is the most common surgical diagnosis, affecting more than 250,000 Americans annually. Delays in diagnosis are associated with increased progression rates to perforated (or ruptured) appendicitis, which leads to more infections after surgery, increases time in the hospital and increases the likelihood of someone returning to the hospital after surgery.

Care for Black patients has historically been concentrated in a relatively small proportion of U.S. hospitals. There is prior evidence that minority patients more frequently receive care at lower-quality hospitals.

“Yet, there is a benefit to patients being treated in predominantly minority-serving hospitals when they are having symptoms of appendicitis,” said senior author Dr. Anne Stey, assistant professor of surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine surgeon.

Stey suggested a reason for that benefit.

“It may be hospitals that are more used to serving racial-ethnic minority patients are better at diagnosing them because they’re more culturally informed and have a better understanding of these patients,” Stey said.

The structure of U.S. healthcare system financing provides lower reimbursements to hospitals serving a higher proportion of uninsured or publicly insured patients, who are frequently minorities, the study authors said.

“The lower reimbursements to hospitals serving Medicaid patients create an unsustainable system,” Stey said. “We have a two-tiered health system. By racially integrating hospitals, our health care system would be able to provide better clinical care to all patients and create a more sustainable health care system.”

In future research, the investigators plan to quantify the cost implications of delayed diagnosis of appendicitis.

Reference:

Reyes AM, Royan R, Feinglass J, Thomas AC, Stey AM. Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis. JAMA Surg. Published online January 18, 2023. doi:10.1001/jamasurg.2022.7055