Black children more likely to experience complications after emergency appendicitis surgery

Black children are four times more likely than white children to experience complications after having their appendix removed, but further assessment is needed to understand the cause of the association, according to research from UCL and Great Ormond Street Hospital.

The study, published in Anaesthesia , aimed to characterise the incidence and epidemiology of postoperative complications in children undergoing appendicectomy in the UK.

Appendicectomy, the removal of the appendix, is a common surgical procedure in children, with around 10,000 operations performed annually in England. Though the risk of mortality is low, complication rates and risk factors are largely unknown

In this study, researchers looked at data from 2,799 children aged 1-16 from 80 hospitals across the UK. Of these, 185 (7%) developed postoperative complications. The majority of complications were infective and treated with antibiotics. 75% of the complications were related to the wound and 25% were either respiratory, urinary, catheter-line-related or of unknown origin.

Analysis of the data showed that black children were at a four times greater risk than white children to suffer complications after surgery. This increased risk was also independent of socioeconomic status or the type of appendicitis identified.

Professor Ramani Moonesinghe, senior author of the study from UCL Surgery & Interventional Science, 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."

This is the first study to report different complication rates in this type of surgery in children in the UK. Studies from the USA have shown that there is substantial evidence to suggest that black children have higher rates of complicated appendicitis, and it has been suggested that 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.

First author Dr Amaki Sogbodjor, from Great Ormond Street Hospital and UCL Surgery & Interventional Science, 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."

Regarding potential limitations to the study, the authors note that there is evidence to suggest black children in the UK present less frequently with appendicitis than white children. For practical reasons, the study did not include children whose parents were unable to speak or understand English sufficiently to provide informed consent to participate. It is possible that this introduces some bias into the cohort and findings, particularly as this cohort of patients may be vulnerable to poor experiences of healthcare due to marginalisation resulting from difficulties with communication.

Furthermore, the data included in the study did not include weight, height or body mass index in the final dataset as a review of data quality after the first 800 patients were recruited indicated that these data were recorded poorly where these children were treated.

Professor Moonesinghe concluded: "Acute appendicitis is a common condition in children, causing morbidity at scale. In the NHS, black children had a significantly higher risk of postoperative morbidity than other children, even after adjusting for household socioeconomic status, acute physiology and long-term health. This health inequality requires urgent further investigation, and development of interventions aimed at resolution."


Dr Matt Midgley

E: m.midgley [at]
  • University College London, Gower Street, London, WC1E 6BT (0) 20 7679 2000