Outcomes of pediatric appendicitis: an international comparison of the United States and Canada

Abstract

Importance: Pediatric appendicitis outcomes have been shown to be influenced by several patient-, surgeon-, and hospital-level factors. However, to our knowledge, no prior studies have investigated the effect of health care systems on outcomes.

Objective: To test the hypothesis that the outcomes of children with appendicitis are better in the Canadian single-payer universal health care system than in the US multipayer system.

Design, setting, and participants: A population-based comparison of outcomes using the US Kids' Inpatient Database and the Canadian Discharge Abstract Database was performed. Subanalyses by age group, US insurance status, and severity of appendicitis (nonperforated or perforated) were also performed. We included patients younger than 18 years coded for nonincidental, urgent appendectomy in the 2006 and 2009 Kids' Inpatient Database (78,625) and 2004 to 2010 Discharge Abstract Database (41,492).

Main outcomes and measures: Perforation rate, normal appendix rate, and length of hospital stay.

Results: Canadian patients had higher rates of normal appendix (6.3% vs 4.3%; P < .001) and perforated appendicitis (27.3% vs 26.7%; P = .04). The Canadian perforation rate fell in the middle between privately insured (24.1%) and publicly insured or noninsured US patients (30.4% and 31.2%, respectively). The Canadian perforation rate was lower in the 0- to 5-year age group (47.7% vs 52.3%; P < .001) and higher in the 12- to 17-year age group (24.7% vs 21.8%; P < .001) vs US patients. In Canada, hospital stay was longer after simple appendicitis (mean [SD], 2.0 [1.2] vs 1.7 [1.2] days; P < .001) and shorter after perforated appendicitis (mean [SD], 4.8 [3.6] vs 5.3 [3.7] days; P < .001).

Conclusions and relevance: Differences in outcomes of pediatric appendicitis between the United States and Canada are influenced by age and US insurance status. These differences are relevant to health policy decisions in both nations.