Increased complications after appendectomy in patients with cerebral palsy: Are special needs patients at risk for disparities in outcomes? Nitasha Dhiman, MSPH, Albert Chi, MD, Timothy M. Pawlik, MD, MPH, David T. Efron, MD, Elliott R. Haut, MD, Eric B. Schneider, PhD, Zain G. Hashmi, MBBS, Valerie K. Scott, MSPH, Xuan Hui, MD, ScM, Mays T. Ali, BS, and Adil H. Haider, MD, MPH, Baltimore, MD Background. Cerebral palsy (CP) is a nonprogressive neurologic disorder. Anecdotal evidence suggests there are worse outcomes in this population after common operative procedures like appendectomy. This study aims to classify whether there are relevant disparities in postoperative outcomes in CP versus non-CP patients after open or laparoscopic appendectomy. Methods. Hospital discharge data from the 2003–2009 weighted Nationwide Inpatient Sample were used. Unadjusted and adjusted multiple logistic regression were used to assess postoperative complications, as well as inpatient mortality, average duration of hospital stay, and cost. Results. Approximately 1,250 patients with CP met the inclusion criteria. After adjusted analysis, CP patients displayed significantly greater odds of the following postoperative complications: Sepsis/organ failure, operation-related infection, pneumonia, urinary tract infection, and acute respiratory distress syndrome. Patients with CP also had a greater cost and in-hospital stay after appendectomy. Conclusion. Patients with CP have greater adjusted odds of complications after open or laparoscopic appendectomy. The mechanisms that led to these disparities need to be studied and may include difficulties in patient assessment and communication. Additional education of healthcare providers to improve recognition of symptoms and care for patients with disabilities may be more immediately helpful in decreasing disparities in outcomes. (Surgery 2013;154:479-85.) From the Center for Surgical Trials and Outcomes Research, The Johns Hopkins School of Medicine, Baltimore, MD ALTHOUGH MARKED ADVANCES have been made in antenatal, natal, and postnatal care, the prevalence of cerebral palsy (CP) among newborns has remained constant over the past several decades. 1 In developed countries, the incidence of CP is 2–2.5 cases per 1,000 live births and it represents the most common cause of physical disability in children. 1,2 CP is a chronic condition, and individ- uals with CP undergo operative treatment not only to address conditions associated with CP, but also to treat common disorders, including cholecystitis and appendicitis. Although CP remains a visible cause of disability in our society today, the associa- tion between this condition and outcomes after common operations is not well understood. To our knowledge, there has never been a large- scale study to observe outcomes in this population after routine operative procedures such as appen- dectomy. It is important to investigate whether there are disparities in outcomes for individuals with CP and better understand if there are aspects of care that can be targeted to improve outcomes and decrease costs. Appendicitis occurs in 7% of the US population or approximately 1.1 per 1,000 people annually, and appendectomy is the most common cause of emergency abdominal operation. 3 Acute appen- dicitis is treated with laparoscopic or open appendectomies, which have low mortality rates of 0.05% and 0.3%, respectively. 4 Complication rates after appendectomy are reported as 8.7% Financial support for this work was provided by: National Institutes of Health/NIGMS K23GM093112-01 and American College of Surgeons C. James Carrico Fellowship for the study of Trauma and Critical Care (Dr Haider). Accepted for publication May 28, 2013. Reprint requests: Adil H. Haider, MD, MPH, Center for Surgery Trials and Outcomes Research, Department of Surgery, The Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6107, Baltimore, MD 21287. E-mail: ahaider1@jhmi.edu. 0039-6060/$ - see front matter Ó 2013 Published by Mosby, Inc. http://dx.doi.org/10.1016/j.surg.2013.05.038 SURGERY 479