Black children suffer ‘more complications’ after appendicitis surgery

Black children in the UK are four times more likely to experience complications after appendicitis surgery than their white counterparts, a study has found.

The study, funded by the Association of Paediatric Anaesthetists of Great Britain and Ireland, looked at 2,799 children from 80 hospitals across the UK aged under 16 who had surgery for suspected appendicitis between November 2019 and January 2022.

Of these, 185 children (7%) developed postoperative complications within 30 days of the surgery. Three-quarters of these complications were related to the wound, while a quarter were respiratory, urinary or catheter-related or of unknown origin.

The study found that black children had a four times greater risk of experiencing complications after the operation, and that this risk was independent of the child’s socioeconomic status and health history.

Appendicitis is one of the most common paediatric surgical emergency with 10,000 performed every year. The authors said that this was the first study to look at the demographic differences of postoperative complication rates in regards to appendicitis.

The researchers said they could not draw firm conclusions regarding why black children had worse outcomes after this type of emergency surgery, and that this apparent health inequality “requires urgent further investigation and development of interventions aimed at resolution”.

The study’s authors note that the research took place during the coronavirus pandemic, and that this could have interrupted the delivery of services across the UK.

The authors said: “Our findings highlight that children from minority ethnic groups represent a population for whom we must better understand and address inequity in outcome.”

One of the limitations of the study acknowledged by the authors was that black children may present less frequently with appendicitis.

Dr Amaki Sogbodjor, a consultant anaesthetist at Great Ormond Street hospital and University College London and lead author of the study, said: “Children with acute appendicitis constitute a particularly useful cohort in which to review the impact of ethnicity on health and healthcare outcomes, due the similarity of the clinical condition – all children present with the same suspected pathology.

“The ‘free at the point of delivery’ NHS healthcare model should reduce the impact of inequitable access to healthcare which may partly explain differential outcomes in other health systems. However, while access to services may be universally available, the utilisation and delivery of services may still differ.

“A review of the processes of care is needed to understand whether the quality of care provided is comparable for all.”

Prof Ramani Moonesinghe, co-author of the study, said: “In the UK NHS, which is a universally accessible healthcare system, ethnicity, but not socioeconomic status, was associated with an increased risk of postoperative complications in children having surgery for acute appendicitis. Further evaluations and interventions are required to address this health inequality in keeping with NHS and international priorities.

“The finding that some ethnic minority groups had worse outcomes, even after accounting for long-term health conditions, factors related to the severity of their acute illness and their socioeconomic position, came as a surprise.”

Moonesinghe added: “Population-level health inequalities, such as the higher incidence of childhood obesity in black and some Asian minorities, may provide some explanation. Additionally, the Race & Health Observatory has previously highlighted the concern that low oxygen levels may be harder to detect in darker-skinned people using pulse oximetry.

“Given that a requirement for oxygen before surgery was another risk factor for postoperative complications, the risk that low oxygen levels may be less likely to be recognised in black children should be investigated further.”