BACKGROUND: Because there is conflicting evidence regarding the benefits of laparoscopic appendectomy, we hypothesized that there would be measurable differences in its use among various socioeconomic groups and geographic areas. METHODS: The Nationwide Inpatient Sample was queried for appendectomies performed between the years of 1997 and 2003. Rates of laparoscopic appendectomy were compared among hospital subtypes and demographic groups. RESULTS: The percentage of appendectomies performed laparoscopically has increased from 19.1% in 1997 to 37.9% in 2003. Only 11.8% of cases of complicated appendicitis were treated laparoscopically in 1997, compared with 23.5% in 2003. Nonwhite patients and those from low-income areas continue to be less likely to undergo laparoscopic appendectomy (P < .001). CONCLUSIONS: Our analysis indicates that despite expanding use of laparoscopic appendectomy nationwide, patients who live in zip codes areas with a preponderance of minorities or low-income earners are more likely to have open appendectomy.