Delays in Diagnosis and Treatment of Appendicitis in Females [ID: 1375790

Abstract

INTRODUCTION: Sex disparities in a perioperative emergency warrant investigation to improve equitable patient care. We investigated whether differences exist in care of appendicitis across patient sex. METHODS: We performed a retrospective cohort study of patients with appendicitis between 2011 and 2020 at an inner-city academic hospital. We collected demographic data and time records of key milestones in clinic care. We used chi-square, paired t test, ANOVA, and Cox proportional hazard analyses to examine differences between sex and other factors. RESULTS: A total of 385 patients were included, 182 (47.3%) females and 203 (52.7%) males. Patients were similar across sex, age, race, reason for visit, and number of emergency room visits. The time to admission for females was longer as compared to males (t(304)=–2.82, P<.05). Cox proportional hazard analysis predicting time to admission based on sex while controlling for age and race showed that females have a longer time to admission (HR 0.73 [95% CI 0.58–0.92]), youngest patients (<15 years) were admitted faster than older-aged patients (HR 2.13 [95% CI 1.45–3.13]), and as compared with Black patients, White patients were admitted faster (HR 1.56 [95% CI 1.06–2.29]). CONCLUSION: Reproductive-aged females had significantly longer times to admission than male peers with the same indication, and White patients were admitted more expeditiously than Black patients. There was a trend of slower surgical consult and admission for females with gynecological disorders. This study suggests that sex biases exist within our system. This highlights that an active effort must be taken to rule out differentials that are not sex based.