Black children in the UK are at four times greater risk of complications following emergency appendicitis surgery compared with white children.
Researchers revealed these alarming disparities in postoperative outcomes recently.
The study, led by Dr Amaki Sogbodjor, a consultant anaesthetist at Great Ormond Street Hospital and University College London, showed that black children faced these greater risks irrespective of their socioeconomic status and health history.
Appendicitis is one of the most prevalent paediatric surgical emergencies; approximately 10,000 cases are treated annually in the UK.
However, this marks the first attempt to scrutinise demographic variances in postoperative complication rates related to appendicitis.
Dr Sogbodjor emphasised the critical need for further investigation into the root causes of these disparities.
‘This apparent health inequality requires urgent further investigation and development of interventions aimed at resolution,’ she said.
Acknowledging the study’s limitations, particularly the potential underrepresentation of black children (due to lower presentation rates for appendicitis), researchers stressed the necessity of addressing inequities in healthcare access and delivery.
Professor Ramani Moonesinghe, co-author of the study, highlighted the unexpected nature of the findings, noting that ethnicity, rather than socioeconomic status, emerged as a significant factor influencing postoperative complications.
She emphasised the importance of comprehensive evaluations and interventions to rectify these health inequalities, aligning with national and international healthcare priorities.
The study’s findings raise important questions about the quality of care provided to children from minority ethnic groups within the NHS system.
Funded by the Association of Paediatric Anaesthetists of Great Britain and Ireland, the team 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.
Dr Sogbodjor said: ‘Children with acute appendicitis constitute a particularly useful cohort in which to review the impact of ethnicity on health and healthcare outcomes, due to 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.’
This is the first study to report different complication rates in this type of surgery in children in the UK.
Looking at studies from the US, there is substantial evidence to suggest that black children have higher rates of complicated appendicitis, and it has been suggested this may in part be related to delays in diagnoses.
However, in this UK study, ethnicity remained a risk factor after adjusting for whether the child had simple or complicated appendicitis.
The Race & Health Observatory has previously highlighted the concern that pulse oximetry may make low oxygen levels more challenging to detect in darker-skinned people.
Professor Moonesinghe said: ‘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.’
The study is published in Anaesthesia, the journal of the Association of Anaesthetists.
