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Georgeades C, Bodnar C, Bergner C, Van Arendonk KJ. Association of complicated appendicitis with geographic and socioeconomic measures in children. Surgery 2024:S0039-6060(24)00563-4. [PMID: 39232975 DOI: 10.1016/j.surg.2024.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/20/2024] [Accepted: 07/29/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Complicated appendicitis, considered a marker of delay in accessing surgical care among children, has been inconsistently associated with race, socioeconomic status, insurance type, rurality, and distance to care. This statewide assessment measured factors associated with complicated appendicitis while overcoming limitations of prior work, namely, selection bias and use of inexact socioeconomic status measures. METHODS Children (<18 years) undergoing appendectomy for appendicitis in Wisconsin from 2018 to 2021 were identified in the Wisconsin Hospital Association database. Patient residence and hospital locations were used to determine rurality, travel distances, and socioeconomic status as measured by Area Deprivation Index, Child Opportunity Index, Community Need Index, and county-level poverty rates. Multivariable logistic regression was used to assess factors associated with complicated appendicitis. RESULTS Among 5,881 children undergoing appendectomy, 1,375 (23.4%) had complicated appendicitis. Adjusting for other variables, complicated appendicitis was associated with younger age (adjusted odds ratio 0.90 per year increase); Hispanic White race/ethnicity (adjusted odds ratio 1.40-1.63); distance to the hospital where surgery was performed (adjusted odds ratio 1.16-1.17 per 10-mile increase); and very low Child Opportunity Index (adjusted odds ratio 1.29), Community Need Index (adjusted odds ratio 1.20 per 1-score increase), and county-level poverty (adjusted odds ratio 1.02 per 1% increase). Insurance type, rurality, and Area Deprivation Index were not associated with complicated appendicitis. Residential county-level complicated appendicitis rates (0.0%-50.0%) had moderate correlation to pediatric county-level poverty rates (rs=0.43). CONCLUSION Complicated appendicitis was associated with Child Opportunity Index, Community Need Index, and county-level poverty but not insurance type, rurality, or Area Deprivation Index. There was geographic variability in complicated appendicitis rates, with modest correlation to county-level poverty. Targeted interventions among Hispanic populations and those with travel- and socioeconomic status-related barriers to care may be beneficial in preventing complicated appendicitis among children.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Catherine Bodnar
- Department of Pathology and Laboratory Medicine, University of Wisconsin Health/University of Wisconsin-Hospital and Clinics, Madison, WI
| | - Carisa Bergner
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI; Department of Surgery, Nationwide Children's Hospital, Columbus, OH. https://twitter.com/KyleVanArendonk
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O'Guinn ML, Keane OA, Lee WG, Feliciano K, Spurrier R, Gayer CP. Clinical Characteristics of Avoidable Patient Transfers for Suspected Pediatric Appendicitis. J Surg Res 2024; 300:54-62. [PMID: 38795673 DOI: 10.1016/j.jss.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Pediatric surgical care is becoming increasingly regionalized, often resulting in limited access. Interfacility transfers pose a significant financial and emotional burden to when they are potentially avoidable. Of transferred patients, we sought to identify clinical factors associated with avoidable transfers in pediatric patients with suspected appendicitis. METHODS We performed a single-center retrospective study at an academic tertiary referral children's hospital in an urban setting. We included children who underwent interfacility transfer to our center with a transfer diagnosis of appendicitis from July 1, 2021 to June 30, 2023. Encounters were designated as either an appropriate transfer (underwent appendectomy) or an avoidable transfer (did not undergo appendectomy). Encounters treated nonoperatively for complicated appendicitis were excluded. Bivariate analysis was performed using Mann-Whitney test and chi-square tests. RESULTS A total of 444 patients were included: 71.2% were classified as appropriate transfers and 28.8% as avoidable transfers. Patients with avoidable transfer were younger compared to those in the appropriate transfer cohort (median age 9 y, interquartile range: 7-13 versus 11 y, interquartile range: 8-14; P < 0.001). Avoidable transfers less frequently presented with the typical symptoms of fever, migratory abdominal pain, anorexia, and nausea/emesis (P = 0.005). Avoidable transfers also reported shorter symptom duration (P = 0.040) with lower median white blood cell count (P < 0.001), neutrophil percentage (P < 0.001), and C-reactive protein levels (P < 0.003). Avoidable transfers more frequently underwent repeat imaging upon arrival (42.9% versus 12.7%, P < 0.001). CONCLUSIONS These findings highlight the importance of clinical history in children with suspected appendicitis. Younger patients without typical symptoms of appendicitis, those with a shorter duration of symptoms, and lower serum inflammatory markers may benefit from close observation without transfer.
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Affiliation(s)
- MaKayla L O'Guinn
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Olivia A Keane
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - William G Lee
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Karina Feliciano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Ryan Spurrier
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Christopher P Gayer
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.
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Daodu O, Aziz S, Morris M, Brindle ME. Geographic Differences in Pediatric Surgical Mortality in Canada: A Retrospective Cohort Study. J Pediatr Surg 2024:161645. [PMID: 39160117 DOI: 10.1016/j.jpedsurg.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/07/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE This study describes differences in postoperative mortality for pediatric patients in rural communities compared to urban communities. BACKGROUND Canada has the second largest land mass in the world, with a population density of 4 people per km2. There are 18 children's hospitals in Canada offering pediatric surgical services, all in urban centres, yet nearly one-fifth of the population lives in rural or remote communities. Children who live in rural settings may have worse surgical outcomes, including mortality rates, compared with urban populations. METHODS Pediatric patients, from birth to 18 years old, who had surgery from January 1, 2011, to December 31, 2021, at a single Children's Hospital were included in the study. Data was obtained from the provincial Operating Room Information System (ORIS) database. Postal code, rural and urban status, distance to children's hospital (0-50 km, 51-100 km, 101-150 km, 151-200 km, and >200 km), and procedure urgency were collected. 30-day mortality for all procedures was collected. RESULTS 85,998 surgical procedures were performed at ACH between 2011 and 2021. 17,773 (20.7%) of patients lived >50 km or more from the hospital - 5,329 (6.2%) 51- 100 km, 4,053 (4.7%) 101-150 km, n=2,323 (2.7%) 151-200 km, and 6,070 (7.1%) >200 km. Rural patients had higher 30-day mortality rates than urban patients, with an odds ratio of mortality (rural vs urban) of 2.30 (95% CI, 0.95 to 5.60). When stratified by distance, patients living closer to the hospital (0-50 km) had lower odds of mortality. CONCLUSIONS Canadian Rural patients have higher operative mortality risks than urban patients. This study identifies a vulnerable group of patients who do not have equal access to care and may experience worse outcomes.
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Affiliation(s)
- Oluwatomilayo Daodu
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Saffa Aziz
- EQuIS Research Platform, University of Calgary, Calgary, AB, Canada
| | - Melanie Morris
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Departments of Pediatric Surgery and Urology, Winnipeg Manitoba, Canada
| | - Mary E Brindle
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; EQuIS Research Platform, University of Calgary, Calgary, AB, Canada
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Zampieri N, Mottadelli G, Camoglio FS. Gender specific data in patients with acute appendicitis: a single center perspective. Minerva Pediatr (Torino) 2024; 76:79-85. [PMID: 33820401 DOI: 10.23736/s2724-5276.21.05872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The influence of sex, socioeconomic status, and other factors on outcomes from acute illness has been found recently with an increasing interest; acute appendicitis is the most frequent urgency in pediatric age. The aim of this study was to show any gender differences. METHODS We retrospectively analyzed the medical records of consecutive patients who underwent surgical exploration for acute appendicitis. Inclusion and exclusion criteria were created. Patient data, demographics, characteristics, and outcomes were studied and evaluated on a gender perspective. RESULTS After reviewing medical charts following the inclusion and exclusion criteria, 364 patients were studied; focusing on final outcomes, it was possible to add news from a gender perspective of appendicitis: gangrenous appendicitis was associated with younger female and older female were more likely to have false positive appendicitis; female had less postoperative pain respect to age-match male for all appendicitis and males had more symptoms respect to females especially for phlegmonous and gangrenous appendicitis. CONCLUSIONS There is a gender difference in appendicitis; as for adult girls appear to be affected less, have fewer symptoms, and have better postoperative results.
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Affiliation(s)
- Nicola Zampieri
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy -
| | - Giulia Mottadelli
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Francesco S Camoglio
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
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Huynh R, Tree K, Builth-Snoad L, Smith M, Fisher D. Impact of socioeconomic status and road distance to hospital on perforated appendicitis rates at a large rural referral centre. ANZ J Surg 2023; 93:1571-1576. [PMID: 36869020 DOI: 10.1111/ans.18334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Socioeconomic status and distance from hospital have been shown to be associated with poor surgical outcomes related to acute appendicitis. Indigenous populations experience greater socioeconomic disadvantages and poorer healthcare access than their non-Indigenous counterparts. This study aims to determine whether socioeconomic status and road distance from hospital are predictors of perforated appendicitis. It will also compare surgical outcomes of appendicitis between Indigenous and non-Indigenous populations. METHODS We performed a 5-year retrospective study of all patients who underwent appendicectomy for acute appendicitis at a large rural referral centre. Patients were identified using the hospital database for theatre events coded as appendicectomy. Regression modelling was used to determine if socioeconomic status and road distance from hospital were associated with perforated appendicitis. The outcomes of appendicitis between Indigenous and non-Indigenous populations were compared. RESULTS Seven hundred and twenty-two patients were included in this study. The rate of perforated appendicitis was not significantly impacted by socioeconomic status (OR 0.993, 95% CI 0.98-1.006, P = 0.316) or road distance from hospital (OR = 0.911, 95% CI 0.999-1.001, P = 0.911). Indigenous patients did not have a significantly higher rate of perforation compared to non-Indigenous patients (P = 0.849) despite having overall lower socioeconomic status (P = 0.005) and longer road distance from hospital (P = 0.025). CONCLUSION Lower socioeconomic status and longer road distance from hospital were not associated with an increased risk of perforated appendicitis. Indigenous populations have poorer socioeconomic status and longer road distance to hospital but did not have higher rates of perforated appendicitis.
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Affiliation(s)
- Roy Huynh
- Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Tree
- Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia
- Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Lily Builth-Snoad
- Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia
| | - Matthew Smith
- Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dean Fisher
- Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia
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Zampieri N, Cinquetti M, Murri V, Camoglio FS. Incidence of appendicitis during SARS-CoV-2 pandemic quarantine. Minerva Pediatr (Torino) 2023; 75:124-125. [PMID: 33016682 DOI: 10.23736/s2724-5276.20.05901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Nicola Zampieri
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy -
| | - Mauro Cinquetti
- Unit of Pediatrics and Neonatology, Maternal-Infant Department, Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Virginia Murri
- Unit of Pediatrics and Neonatology, Maternal-Infant Department, Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Francesco S Camoglio
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
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Yang Y, Guo C, Gu Z, Hua J, Zhang J, Qian S, Shi J. The Global Burden of Appendicitis in 204 Countries and Territories from 1990 to 2019. Clin Epidemiol 2022; 14:1487-1499. [PMID: 36536897 PMCID: PMC9758930 DOI: 10.2147/clep.s376665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/01/2022] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE Appendicitis is a common surgical emergency. This study aimed to estimate the worldwide burden and trends of appendicitis from 1990 to 2019. METHODS Data on appendicitis were derived from the Global Burden of Disease 2019. Incidence and disability-adjusted life-years (DALYs) data were analyzed at global, regional, and national levels and stratified by sex, age, and socio-demographic index. The estimated annual percentage change and relative change were used to assess changing trends. Pearson's correlation test was used to assess the correlation between different measures. RESULTS Global incidence grew by 63.55% between 1990 and 2019, age-standardized incidence rate climbed by an estimated percentage change of 0.58 per year, whereas the number of DALY declined by 31.93% during the same period, with an estimated annual percentage change of -2.77. In 2019, the areas of Andean Latin America and the Caribbean had the highest age-standardized rates of incidence and DALYs. While South Asia saw the largest increase in age-standardized incidence rates, Andean Latin America saw the biggest decline in age-standardized rates of incidence and DALYs. At the national level, Bangladesh, Bhutan, and Peru were the top three countries in terms of age-standardized incidence rates in 2019, and Honduras, Haiti, and the Central African Republic held the highest age-standardized DALY rates. Ethiopia experienced the most age-standardized incidence rate increase, and Peru saw the largest decline in age-standardized rate of incidence and DALYs. Significant negative correlations between age-standardized DALY rates and socio-demographic index, between estimated annual percentage change and age-standardized incidence rates, were observed at the national level. CONCLUSION Appendicitis remains a major global health concern. Although the trends in DALYs decreased, the burden of incidence increased from 1990 to 2019. Policymakers should create health policies adapted to local conditions to manage the burden of appendicitis globally.
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Affiliation(s)
- Yongping Yang
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Chengjun Guo
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Zhaoxuan Gu
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Junjie Hua
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jiaxuan Zhang
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Siyu Qian
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jian Shi
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
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Juan HL, Nicolas AM, Daniela CNL, Lineth ORM, María RHA, Camila RQM, Gabriela TPP, Felipe CVL, Catalina C. Use of a bipolar device (LigaSure) to seal the appendiceal stump in pediatric laparoscopic appendectomy: 10-year Latin-American experience. J Pediatr Surg 2022:S0022-3468(22)00677-7. [PMID: 36396473 DOI: 10.1016/j.jpedsurg.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/24/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Closure of the appendiceal stump is a critical step during an appendectomy. There is a lack of knowledge about the feasibility of using electrosurgical devices for the occlusion of the appendix. This study aims to determine the safety of this technique in pediatric patients. METHODS We performed a cross-sectional analytical study in patients less than 18 years of age treated at Hospital Militar Central Colombia between 2012 and 2021. Our institution's ethics committee approved the study. We analyzed the data using SPSS 22 statistical program. We present frequencies for qualitative variables and measures of central tendency or dispersion for quantitative variables depending on the distribution measured by the Kolmogorov-Smirnov test. In addition, we measured the association of nominal variables with the Chi-square test or Fisher's exact test. For numerical variables, the difference of means with the Student's t-test or the difference of medians with the Mann-Whitney U test. RESULTS We treated 209 patients. One hundred sixteen (55.5%) were boys, and the mean age was 9.7 years (SD 3.2). The median intraoperative time was 60 min, and the hospital stay was 2.8 days on average. There were no cases of stump leakage, and only two patients (1%) had an organ-space surgical site infection, which was unrelated to the closure technique. We found no association between procedural complications and appendicular status (p = 0.450). CONCLUSIONS Our research suggests that using a bipolar sealing device (Ligasure, Medtronic, USA) for appendiceal stump closure in pediatric patients undergoing laparoscopic appendectomy is feasible and should be further studied. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | | | | | | | | | - Cabrera-Vargas Luis Felipe
- Hospital Militar Central. Tv 3c # 49-02, Bogota, Colombia; Universidad Militar Nueva Granada. Transversal 3A No 49-00, Bogota, Colombia
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Yeob KE, Kim SY, Park JE, Park JH. Complicated Appendicitis Among Adults With and Without Disabilities: A Cross-Sectional Nationwide Study in South Korea. Front Public Health 2022; 10:813608. [PMID: 35444990 PMCID: PMC9013817 DOI: 10.3389/fpubh.2022.813608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAppendicitis is usually diagnosed based on a reliable set of signs and symptoms, and can be effectively treated with surgery, with low morbidity and mortality rates. However, appendicitis is often overlooked in vulnerable populations, including people with disabilities. This study compared 10-year trends of complicated appendicitis between South Koreans with a disability, according to disability severity and type, and those without disabilitiesMethodsTo identify cases of appendicitis, we used the DRG codes in the National Health Information Database of South Korea. Patients with appendicitis were classified in terms of severity based on the DRG codes. Age-standardized incidence rates were calculated for each year during 2008–2017 according to the presence, type, and severity of the disability. Factors associated with complicated appendicitis were examined by multivariate logistic regression using the most recent data (i.e., 2016–2017).ResultsThe incidence of complicated appendicitis was higher in people with disabilities, especially those with severe disabilities (26.9 vs. 11.6%). This difference was particularly marked when considering those with a severe disability (aOR = 1.868, 95% CI:1.511–2.309), internal organ problems (aOR = 10.000, 95% CI:5.365–18.638) or a mental disability (aOR = 2.779, 95% CI:1.563–4.939).ConclusionsThe incidence of complicated appendicitis was higher in people with disability than in those without disability in all years. There was a substantial difference in the incidence of complicated appendicitis between the severe disability and non-disabled groups. Among the various disability types, the incidence of complicated appendicitis was highest for major internal organ problems, followed by intellectual or psychological disabilities. Our findings may be explained by barriers to healthcare access among people with disabilities, particularly those with a severe disability, internal organ problem, or mental disability.
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Affiliation(s)
- Kyoung Eun Yeob
- Institute of Health and Science Convergence, Chungbuk National University, Cheongju, South Korea
| | - So Young Kim
- Institute of Health and Science Convergence, Chungbuk National University, Cheongju, South Korea
- Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, South Korea
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Jong Eun Park
- Institute of Health and Science Convergence, Chungbuk National University, Cheongju, South Korea
| | - Jong Hyock Park
- Institute of Health and Science Convergence, Chungbuk National University, Cheongju, South Korea
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
- *Correspondence: Jong Hyock Park
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Swift K, Thompson F, Roeder L, Choy KT, McDonald M, de Costa A. Appendicitis in Far North Queensland: a new take on an old story. ANZ J Surg 2021; 92:114-120. [PMID: 34931426 DOI: 10.1111/ans.17404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/18/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). METHODS Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012-2018. Population data for the same time period provided rates. RESULTS Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re-admission rate was 3.8% and all-cause mortality was 0.03%. CONCLUSION The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non-Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.
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Affiliation(s)
- Kate Swift
- Department of Surgery, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Fintan Thompson
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Luisa Roeder
- Technical University of Munich, Department of Sport and Health Sciences, Chair of Human Movement Science, Munich, Germany.,Faculty of Health, School of Exercise and Nutrition Sciences, Movement Neuroscience Program, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kay Tai Choy
- Department of Surgery, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
| | - Malcolm McDonald
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alan de Costa
- Department of Surgery, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Seqsaqa M, Rozeik AE, Khalifa M, Ashri HNA. Geographic influence on postoperative complications in children with complicated appendicitis: a single center study. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute appendicitis is one of the most common abdominal emergencies in children. Complicated appendicitis is much more common in pediatric age group than in adults due to probability of delay in diagnosis or misdiagnosis. Geographic status has an influence on the clinical course of such surgical cases. This prospective comparative study was conducted at the pediatric surgery department in our hospital in Egypt during the period from December 2018 to August 2019, aiming to find the relation between residence of patients and occurrence of post-operative complications among patients in Sharkia Governorate, Egypt. Patients were divided into two groups: rural and urban. Data recorded included demographic data, preoperative assessment, operative findings, postoperative course, postoperative complications, and follow-up.
Results
Sixty patients were included in the study, 32 of them were from rural areas, and 28 were from urban areas. There was no significant difference between them regarding demographics. Duration of symptoms was significantly longer with rural group (3.7 ± 1.4 vs. 3.07 ± 0.92 days). Length of hospital stay was significantly longer with the rural group (4.7 ± 1.7 vs. 4.7 ± 1.7 days). The rate of wound infection was significantly higher with the rural group (34.37% vs. 10.7%), while other postoperative complications were increased with rural group, but that was not statistically significant. The regularity of follow-up was higher with the urban group.
Conclusions
Children with complicated appendicitis from rural areas are at higher risk for occurrence of postoperative complications and poor outcome, with less regularity in follow-up. This is because of many obstacles they faced, including difficulties of transportation, insufficient medical services, and low socioeconomic and educational statuses.
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Abstract
OBJECTIVES To describe the geography of pediatric critical care services and the relationship between poverty and distance to these services across the United States. DESIGN Retrospective, cross-sectional study. SETTING Contiguous United States. PATIENTS Children less than 18 years as represented in the 2016 American Community Survey. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Pediatric critical care services were geographically concentrated within urban areas, with half of all PICUs located within 9.5 miles of another (interquartile range, 3.4-51.5 miles). Median distances from neighborhoods to the nearest unit increased linearly with Area Deprivation Index (p < 0.001), such that the median distance from the least privileged neighborhoods was nearly three times that of the most privileged neighborhoods (first decile = 7.8 miles [interquartile range, 3.4-15.8 miles] vs tenth decile = 22.6 miles [interquartile range, 4.2-52.5 miles]; p < 0.001). A relationship between neighborhood poverty and distance to a PICU was present across all U.S. regions and within urban/suburban and rural areas. CONCLUSIONS In the United States, the distance to pediatric critical care services increases with poverty. This carries implications for access to care and health outcome disparities.
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Affiliation(s)
- Lauren E Brown
- Division of Critical Care, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Urbano L França
- Division of Critical Care, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael L McManus
- Division of Critical Care, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Withers N, Hepburn L, Palmer J, Evans F, Mosher J, Dasril J, Liyanage C, Eglinton T, Sakowska MM. Multicentre study of appendicitis management comparing a large South Island metropolitan hospital, to its referring regional and rural centres. ANZ J Surg 2021; 91:2054-2059. [PMID: 34405500 DOI: 10.1111/ans.17125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Globally, patients presenting with acute surgical disease in rural areas have poorer outcomes when compared to urban areas; little data are available regarding outcomes for New Zealand (NZ) rural patients. This study aimed to compare the surgical management of appendicitis in a large metropolitan centre with its regional referral centres. METHODS In this retrospective cohort study, patient data were collated from the studied centres between November 2014 and October 2019. In addition to patient demographics, patterns of referral and presentation, the primary outcome was time to the theatre; secondary outcomes were perforation rates, length of stay and complications. Data are presented as medians (interquartile range). RESULTS A total of 3533 patients underwent appendicectomy over the period studied. For those presenting directly to the metropolitan centre, the median wait-time to the theatre was 16 h (9.2-23.2); if patients were transferred, they waited for 20.8 h (13.6-27). Patients presenting to regional centres waited for 7.6 h (4.5-15.4, P < 0.001). Perforation rates for transferred patients were 31% which was greater than for those presenting to the metropolitan (20%) or regional centres (17%, P = 0.014). Complications were also highest in transferred patients (20%) when compared to the metropolitan (17%) or regional centres (10%, P < 0.001). CONCLUSION Patients who were transferred to Christchurch Hospital from rural centres without surgical services had a longer wait-time than those who presented to Christchurch Hospital directly or were treated in regional centres. This was associated with higher rates of perforated appendicitis.
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Affiliation(s)
- Nicole Withers
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Lucy Hepburn
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Jethro Palmer
- Department of Surgery, Timaru Hospital, Timaru, New Zealand
| | - Fergus Evans
- Department of Surgery, Grey Base Hospital, Greymouth, New Zealand
| | - Jamie Mosher
- Department of Surgery, Grey Base Hospital, Greymouth, New Zealand
| | - Juni Dasril
- Department of Surgery, Wairau Hospital and Health Centre, Blenheim, New Zealand
| | - Chris Liyanage
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Tim Eglinton
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
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Carmichael H, Tran B, Velopulos CG. When more is less: Urban disparities in access to surgical care by transportation means. Am J Surg 2021; 223:112-119. [PMID: 34425989 DOI: 10.1016/j.amjsurg.2021.07.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Structural factors limiting access to surgical care require elucidation. We hypothesize transportation time to hospitals with surgical capacity disproportionately burdens minority populations. METHODS We identified hospitals with surgical capacity within a 20-mile radius of our city center. Using geocoding, we estimated travel times from each census tract to the nearest facility by car or public bus. RESULTS For 143 tracts within the county, drive time was 13 ± 4 min and bus time was 33 ± 15 min. Only 41.2% of the population had a facility within 30 min by bus; access was further diminished for those with minority race/ethnicity and/or no insurance. Bus time was associated with percent minority population in a census tract: for each 10% increase in minority population there was a 4.3-min increase in bus time (p < 0.001) when controlling for socioeconomic status and other characteristics. CONCLUSIONS Geographic information systems analysis has potential to identify communities with disproportionate burden to access surgical services.
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Affiliation(s)
- Heather Carmichael
- Department of Surgery University of Colorado 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA.
| | - Billy Tran
- Department of Surgery University of Colorado 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA.
| | - Catherine G Velopulos
- Department of Surgery University of Colorado 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA; Surgical Outcomes and Applied Research University of Colorado Anschutz Medical Campus, 12631 East 17th Ave., Mail Stop C313, Aurora, CO, 80045, USA.
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Spatial-temporal clusters of pediatric perforated appendicitis in California. J Pediatr Surg 2021; 56:1208-1213. [PMID: 33752913 DOI: 10.1016/j.jpedsurg.2021.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Perforated appendicitis is a well-documented child health disparity. Geographic patterns in perforated appendicitis exist in several United States regions, but such patterns have not been described in California. We aimed to analyze spatial-temporal patterns of pediatric perforated appendicitis and identify population characteristics contributing to these cluster patterns. METHODS We geocoded risk-adjusted perforated appendicitis rates per 1000 appendicitis cases in patients 1-17 years from 2005-2015 in California. We performed a space-time cube analysis to identify hot spot trends. We performed logistic regression to estimate rural classification associated with spatial-temporal hot spots and multivariate analysis to assess effects of socioeconomic factors. RESULTS In 2005-2015, 43,888 cases of pediatric perforated appendicitis occurred in California. Median risk-adjusted perforated appendicitis rate was 312 per 1000 appendicitis cases. We identified 11 spatial-temporal hot spots of perforated appendicitis. Rural micropolitan counties had 14 times higher odds of being classified as a hot spot (p<0.05, 95% CI 1-185). Poverty was a significant predictor of high perforated appendicitis median risk-adjusted rate (p<0.004). CONCLUSIONS We identified 11 California hot spots of perforated appendicitis that persisted across a ten-year time span. Incorporating geography alongside our understanding of socioeconomic factors is a critical step in addressing this important child health disparity.
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Zampieri N, Murri V, Cinquetti M, Camoglio FS. Incidence of appendicitis during SARS-CoV-2 pandemic quarantine. Pediatr Int 2021; 63:484-485. [PMID: 33788358 PMCID: PMC8251481 DOI: 10.1111/ped.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Nicola Zampieri
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Paediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Virginia Murri
- Unit of Pediatrics and Neonatology, Maternal-Infant Department, Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Mauro Cinquetti
- Unit of Pediatrics and Neonatology, Maternal-Infant Department, Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Francesco Saverio Camoglio
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Paediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
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Nicola Z, Virginia M, Mauro C, Amedeo E, Saverio CF. Quarantine and Appendicitis: A Macro-Area Experience. Pediatr Gastroenterol Hepatol Nutr 2021; 24:75-80. [PMID: 33505896 PMCID: PMC7813574 DOI: 10.5223/pghn.2021.24.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Appendicitis is the most frequent urgency in pediatric age; the aim of this study was to investigate the association of quarantine for severe acute respiratory syndrome coronavirus 2 pandemic and the incidence of pediatric appendicitis in a specific macro area. METHODS We retrospectively analyzed the medical records of consecutive patients who underwent surgical exploration for acute appendicitis in the period March-April since 2014. This specific quarantine period was divided into two phases as indicated by National government. Patient data, demographics, characteristics and outcomes were studied and evaluated comparing patients treated during quarantine especially phase 1 vs. phase 2 (March-April 2020). RESULTS After reviewing medical charts following the inclusion and exclusion criteria, 155 patients were studied; focusing on the final outcome, it is possible to show a decreased amount of appendicitis during phase 1 and a progressive increase during phase 2; respect to previous years, there was a statistical increase in severity of appendicitis during quarantine (gangrenous vs. phlegmonous appendicitis). CONCLUSION During this specific quarantine there was a reduction in appendicitis and a progressive increase during phase 2. These results offer new perspective among disease incidences during lockdown.
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Affiliation(s)
- Zampieri Nicola
- Department of Surgery, Woman and Child Hospital, Dentistry, Paediatrics and Gynecology; Division of Pediatric Surgery, University of Verona, Verona, Italy
| | - Murri Virginia
- Department of Maternal-Infant, Unit of Pediatrics and Neonatology, Fracastoro Hospital, Verona, Italy
| | - Cinquetti Mauro
- Department of Maternal-Infant, Unit of Pediatrics and Neonatology, Fracastoro Hospital, Verona, Italy
| | - Elio Amedeo
- Department of Surgery, Fracastoro Hospital, Verona, Italy
| | - Camoglio Francesco Saverio
- Department of Surgery, Woman and Child Hospital, Dentistry, Paediatrics and Gynecology; Division of Pediatric Surgery, University of Verona, Verona, Italy
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Golz RA, Flum DR, Sanchez SE, Liu X, Donovan C, Drake FT. Geographic Association Between Incidence of Acute Appendicitis and Socioeconomic Status. JAMA Surg 2020; 155:330-338. [PMID: 32129808 DOI: 10.1001/jamasurg.2019.6030] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Some studies based on proportions of patients with perforated appendicitis (PA) among all patients with acute appendicitis (AA) have found an association between socioeconomic status (SES) and risk of perforation. A potential limitation is their use of proportions, which assumes that incidence of AA is evenly distributed across populations at risk. This assumption may be invalid, and SES may have a more complex association with both AA and PA. Objective To generate population-based incidences of AA and PA and to examine geographic patterns of incidence alongside geographic patterns of SES. Design, Setting, and Participants Retrospective study of data from Washington's Comprehensive Hospital Abstract Reporting System and the 2010 US census. Geographic methods were used to identify patterns of age- and sex-standardized incidence in Washington State between 2008 and 2012. The study included all patients discharged with International Classification of Diseases, Ninth Revision codes for AA or PA. Data were analyzed between November 2016 and December 2018. Exposures Location of primary residence. Main Outcomes and Measures Age- and sex-standardized incidence for AA and PA was generated for each census tract (CT). Global spatial autocorrelation was examined using Moran index (0.0 = completely random incidence; 1.0 = fully dependent on location). Clusters of low-incidence CTs (cold spots) and high-incidence CTs (hot spots) were identified for AA. Census-based SES data were aggregated for hot spots and cold spots and then compared. Results Statewide, over the 5-year study period, there were 35 730 patients with AA (including 9780 cases of PA), of whom 16 574 were women (46.4%). Median age of the cohort was 29 years (IQR, 16-48 years). Statewide incidence of AA and PA was 106 and 29 per 100 000 person-years (PY), respectively. Crude incidence was higher within the male population and peaked at age 10 to 19 years. Age- and sex-standardized incidence of AA demonstrated significant positive spatial autocorrelation (Moran index, 0.30; P < .001), but autocorrelation for PA was only half as strong (0.16; P < .001). Median incidence of AA was 118.1 per 100 000 PY among hot spots vs 86.2 per 100 000 PY among cold spots (P < .001). Socioeconomic status was higher in cold spots vs hot spots: mean proportion of college-educated adults was 56% vs 26% (P < .001), and mean per capita income was $44 691 vs $30 027 (P < .001). Conclusions and Relevance Age- and sex-standardized incidence of appendicitis is not randomly distributed across geographic subunits, and geographic clustering of AA is twice as strong as PA. Socioeconomic advantages, such as higher income and secondary education, are strongly associated with lower incidence of AA. These findings challenge conventional views that AA occurs randomly and has no predisposing characteristics beyond age/sex. Socioeconomic status, and likely other geographically circumscribed factors, are associated with incidence of AA.
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Affiliation(s)
- Reece A Golz
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Geography, San Francisco State University, San Francisco, California
| | - David R Flum
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Sabrina E Sanchez
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Surgery, University of Washington School of Medicine, Seattle
| | - XiaoHang Liu
- Department of Geography, San Francisco State University, San Francisco, California
| | - Courtney Donovan
- Department of Geography, San Francisco State University, San Francisco, California
| | - F Thurston Drake
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Surgery, University of Washington School of Medicine, Seattle
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McEvoy CS, Ross-Li D, Norris EA, Ricca RL, Gow KW. From far and wide: Geographic distance to pediatric surgical care across Canada. J Pediatr Surg 2020; 55:908-912. [PMID: 32063366 DOI: 10.1016/j.jpedsurg.2020.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/25/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Canada is the second largest country in the world, with most of the population located in the southern-most portion of its geography. We sought to define the relative distribution of pediatric surgeons to potential pediatric patients using data from the Canadian census. METHODS The 2011 Canadian Census and a convenience sample of current Canadian pediatric surgeons were used to calculate straight-line distances between pediatric surgeon postal code centroids and census dissemination block centroids. RESULTS Currently, there are 74 practicing pediatric surgeons in Canada; 493,345 populated census blocks were identified, and 7,752,075 children were enumerated. The median (IQR) kilometers to the closest pediatric surgeon was 27.99 (11.35, 85.47) kilometers, and 22.7% of Canadian children lived more than 100 km from care. Nearly 13% of children lived greater than 200 km from the nearest pediatric surgeon. CONCLUSION More than 1.7 million Canadian children, nearly one quarter of all Canadian children, live greater than 100 km from the closest pediatric surgeon. This identifies a disparate group of patients who do not have an equal access-to-care as compared to others in the country. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christian S McEvoy
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA; Department of Heath Analysis, Navy and Marine Corps Public Health Center, Portsmouth, VA.
| | | | - Emily A Norris
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Robert L Ricca
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA; Department of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Kenneth W Gow
- Departments of Surgery, General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
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Springer JE, Doumouras AG, Eskicioglu C, Hong D. Regional Variation in the Utilization of Laparoscopy for the Treatment of Rectal Cancer: The Importance of Fellowship Training Sites. Ann Surg Oncol 2019; 27:2478-2486. [DOI: 10.1245/s10434-019-08115-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Indexed: 01/22/2023]
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