Determinants of surgical approach to pediatric appendicitis in Brazil.

Abstract

Introduction: Appendicitis is the most prevalent surgical emergency in children. This study explores the social and clinical determinants affecting the surgical approach for pediatric appendectomy in Brazil.

Methods: All patients aged 0-16 years hospitalized and operated on for acute appendicitis in Brazil during 2022 were identified in the Brazilian national healthcare database. Data reviewed included patient demographics, hospital resources and location. Univariable and multivariable logistic regression models were used for statistical analysis.

Results: We identified 24,088 patients, of which 8768 (36.4%) were female, with a mean age of 10 years. 9690 (40.2%) of patients were white and 14.398 (59.8%) were non-white (including brown, black, asian or indigenous). Geographically, more patients were from the Southeast region. 21,627 (89.8%) of cases were open appendectomies. On univariable analysis, factors significantly influencing the selection of laparoscopic appendectomy included being female, white race, and higher socioeconomic status. The severity of appendicitis did not significantly affect the surgical approach. On multivariable analysis, white race (OR 1.934, [1.759, 2.126]), advanced hospital facilities (OR 5.987, [5.395, 6.644]), and hospitals located in the wealthier Southern region (OR 4.277, [3.884, 4.710]) were significant predictors of a laparoscopic approach.

Conclusion: The surgical approach for pediatric appendectomy in Brazil was determined by social determinants rather than by disease severity. The findings emphasize the need for targeted interventions to ensure equitable healthcare access and approaches in pediatric surgery.