Withstanding the COVID19 pandemic - A tertiary children’s hospital’s commitment to equitable care

Introduction: The COVID-19 pandemic led to perceived increases in the rates of complicated appendicitis. Multiple studies have shown, both in adults and children, higher rates of complicated appendicitis among patients with Medicaid insurance. At our institution, we previously found that, contrary to statewide and nationwide findings, no differences in complicated appendicitis rates existed based on age, sex, race, insurance status, socioeconomic status, and income level. The purpose of this study was to determine if the COVID-19 pandemic altered our previous findings. Methods: The electronic medical record of a large tertiary children’s hospital was queried for all patients with ICD 10 appendicitis codes from 1/1/2017-12/31/2020. Patient records were reviewed to determine complicated (defined as having either a hole in the appendix, extraluminal fecalith, well-formed abscess, or frank stool in the abdomen) vs. uncomplicated appendicitis. Demographic information including age, sex, race, ethnicity, and insurance type were collected. Rates of complicated appendicitis were compared across years. Correlation between rates of complicated appendicitis and demographic variables was determined both within and across years. Results: The rate of complicated appendicitis was not significantly different across years from 2017-2020. There was no significant difference in the rate of complicated appendicitis based on age, sex, race, ethnicity, or insurance type. Conclusion: While some U.S. centers and those abroad found a significantly higher rate of complicated appendicitis in 2020 compared to prior years, the rate of complicated appendicitis at a large tertiary children’s hospital did not change during the pandemic. No disparities exist based on age, sex, race, ethnicity, or insurance type.