Postdischarge Racial and Ethnic Disparities in Pediatric Appendicitis: A Mediation Analysis.

INTRODUCTION: Significant racial and ethnic disparities exist for children presenting with acute appendicitis; however, it is unknown if disparities persist after initial management and hospital discharge. MATERIALS AND METHODS: We performed a retrospective cohort study of children (aged < 18 y) who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals between 2017 and 2019. Primary outcomes were 30-d emergency department (ED) visits and 30-d inpatient readmission. Hierarchical multivariable logistic regression models were developed to determine the association of race and ethnicity on the primary outcomes. Inverse odds-weighted mediation analyses were used to estimate the degree to which complicated disease, insurance status, urbanicity, and residential socioeconomic status- mediated disparate outcomes. RESULTS: A total of 67,303 patients were included. Compared with Non-Hispanic White children, Non-Hispanic Black (NHB) (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.23-1.59) and Hispanic/Latinx (HL) children (OR 1.55, 95% CI 1.44-1.67) had higher odds of ED visits. Only NHB children had higher odds of readmission (OR 1.43, 95% CI 1.30-1.57). On a multivariable analysis, NHB (adjusted OR 1.19, 95% CI 1.04-1.36) and HL (adjusted OR 1.19, 95% CI 1.09-1.31) children had higher odds of ED visits. Insurance, disease severity, socioeconomic status, and urbanicity mediated 61.6% (95% CI 29.7-100%) and 66.3% (95% CI 46.9-89.3%) of disparities for NHB and HL children, respectively. CONCLUSIONS: Children of racial and ethnic minorities are more likely to visit the ED after treatment for acute appendicitis, but HL patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence. A lack of appropriate postdischarge education and follow-up may drive disparities in healthcare utilization after pediatric appendicitis.

Association of gastrostomy placement on hospital readmission in premature infants.

OBJECTIVE: We sought to determine the association of gastrostomy placement on post-NICU-discharge resource utilization in premature infants. STUDY DESIGN: We performed a propensity-matched retrospective cohort study of NICU infants born under 32-week gestation in US Children's Hospitals. Multivariable logistic regression and propensity score-matching were used to determine the association of gastrostomy placement on 90-day hospital readmissions and emergency department visits adjusting for salient patient characteristics. RESULT: A total of 12,621 premature infants were included of which 697 (5.5%) underwent gastrostomy placement. After propensity matching, infants who underwent gastrostomy placement have a higher rate of 90-day inpatient readmission (41.9 vs 26.3%, p < 0.001) and emergency department visit (27.1 vs 16%, p < 0.001). CONCLUSION: Premature infants who undergo gastrostomy placement have increased the risk of inpatient readmission and emergency department visits after NICU discharge. Gastrostomy placement likely is both a driver and marker for increased resource utilization in premature infants post-NICU discharge.