Complicated Appendicitis in a Universal Healthcare System: Do Ethnic Disparities Persist?

While ethnic disparities in appendicitis outcomes have been previously documented, limited data exist regarding their influence on the incidence of complicated appendicitis within population covered by universal health insurance. This study aimed to assess whether ethnicity (Israeli Jewes vs. Israeli Arabs) is independntly accosioated with the risk of complicated appendicitis in the context of Israel’s universal healthcare system. All adult patients who underwent appendectomy at our institution between January 2010 and December 2021. The primary outcome was appendicitis severity, categorized as complicated or uncomplicated based on pathology reports. Secondary outcomes included length of hospital stay and rehospitalization within six months. Univariable and multivariable logistic regression analyses were performed to identify factors associated with complicated appendicitis. A total of 2,943 patients were included. In the multivariable logistic regression analysis, prolonged in-hospital delay before surgery exceeding 12 h increased the risk of complicated appendicitis (OR = 1.41; 95% CI: 1.14–1.75; p = 0.002). Age over 60 years doubled the risk of complicated appendicitis compared to younger patients (OR = 2.42; 95% CI: 1.81–3.24; p < 0.001). Although Jewish patients were older and had higher rates of complicated appendicitis, ethnicity was not independently associated with complicated appendicitis after adjustment for age, comorbidities, and surgical delay. Ethnicity was not an independent risk factor for complicated appendicitis in a population with universal health coverage. Older age and prolonged in-hospital delay were the primary predictors of complicated disease.