Symptomatic Cholelithiasis: Racial Differences in Urgency of Surgery for Pediatric Patients

Shenoy R, Massoumi R, Maggard-Gibbons M, Russell MM, Lee SL. Symptomatic Cholelithiasis: Racial Differences in Urgency of Surgery for Pediatric Patients. [Abstract]. Journal of the American College of Surgeons. 2020 Oct 1; 231(4S2):e181.

INTRODUCTION: Access to care may be an important determinant of disparities for minority patients. Receipt of urgent vs elective surgery may serve as a proxy for poor access. We examined access to cholecystectomy for symptomatic cholelithiasis (SC) by comparing the pediatric to adult population. We hypothesized that rates of urgent surgery would be higher for minority patients in both groups. METHODS: Patients undergoing cholecystectomy for SC were identified from the ACS-NSQIP pediatric ( < 18yo) (2012-2018) and adult (_ 18yo) (2017) databases. The main outcome was surgery acuity. Primary regressor of interest was race/ethnicity. Models were adjusted for demographics and comorbidities. RESULTS: 3,491 pediatric and 6,219 adult patients underwent cholecystectomy for SC. Elective cholecystectomy was performed over 75% of the time for all patients. All pediatric minority groups had similar unadjusted rates of urgent surgery (9.6%-14.3%). All adult minority groups had higher odds for experiencing urgent cholecystectomy with Hispanics having almost double the odd for urgent cholecystectomy. Like adults, pediatric Hispanic patients had increased odds (aOR 1.75, 1.26-2.42) for urgent surgery, but unlike adults Black pediatric patients had decreased odds and differences for the other minority groups were not significant. CONCLUSION: All minority groups in adults had higher odds for urgent cholecystectomy for SC, but in children this trend did not persist. These findings demonstrate the need to identify factors present in minority groups that may be differentially affecting treatment processes for adults vs children. Understanding this variation is critical to standardizing treatment for SC and promoting equitable outcomes.