Abstract
Background
Acute appendicitis is one of the most common abdominal emergencies, with management approaches that vary depending on the available resources and setting. However, there is a lack of studies on the differences of surgical outcomes and quality of care between tertiary care hospitals and regional hospitals.
Methods
This multicenter retrospective study included 2158 consecutive adult patients between January 2014 and June 2018 at three hospitals. The patient cohort was divided into regional hospital group (N = 1223) and tertiary care hospital group (N = 935). Baseline characteristics and perioperative outcomes were compared, and factors associated with surgical delay and postoperative complication were investigated.
Results
Patients in tertiary care hospital group had longer surgical waiting time (17.3 vs. 12.0 h, p < 0.001), higher risks of surgical delay exceeding 24 h (OR = 2.94, 95% CI 2.17–4.01, p < 0.001), longer operation time (64 vs. 50 min, p < 0.001), more appendix perforation (22.4 vs. 13.3%, p < 0.001), and higher hospital cost compared with regional hospital group. In multivariate analysis, factors associated with surgical delay were tertiary care hospital (OR = 2.94, 95% CI 2.18–4.01, p < 0.001) and delay diagnosis (OR = 18.7, 95% CI 11.7–30.1, p < 0.001), while those associated with postoperative complications were older age (OR = 1.02, 95% CI 1.00–1.04, p = 0.013), male sex (OR = 2.38, 95% CI 1.11–5.52, p = 0.031), surgical delay (OR = 2.99, 95% CI 1.30–6.47, p = 0.007), and appendix perforation (OR = 5.61, 95% CI 2.72–11.85, p < 0.001).
Conclusions
Patients at tertiary care hospitals had longer waiting time, more surgical delays, and appendix perforations, and these were risk factors of postoperative complications. Establishing an effective referral system to redirect appendicitis patients with less complex medical histories from tertiary care hospitals to regional hospitals may enhance the quality of patient care and outcomes, while also reducing medical costs.
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Availability of data and materials
The datasets generated or analyzed during the current study are not publicly available due ethical regulations of National Taiwan University Hospital but are available from the corresponding author on reasonable request.
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Acknowledgements
The authors thank the staff of the National Taiwan University Hospital-integrated Medical Database (NTUH-iMD) and the Core Labs, Department of Medical Research, National Taiwan University Hospital for technical support.
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Ya-Wen Hsiao contributed to data collections, data analysis, and writing. Chih-Yang Hsiao contributed to conceptualization, study design, data collections, data analysis, and revision of manuscript. John Huang contributed to literature review and manuscript editing. Peng-Sheng Lai contributed to data collections and project administration. Po-Yen Chen contributed to documents for ethics approval and project administration. All authors had read and approved the manuscript submission.
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This study was approved by Research Ethics Committee of the National Taiwan University Hospital (Protocol ID: 201904076RINA) and was carried out in accordance with the approved guidelines.
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Hsiao, YW., Hsiao, CY., Huang, J. et al. Surgical Outcomes and Quality of Care Among Adult Appendicitis Patients: A Comparative Study of Tertiary Care Hospitals and Regional Hospitals. World J Surg 47, 3149–3158 (2023). https://doi.org/10.1007/s00268-023-07219-7
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DOI: https://doi.org/10.1007/s00268-023-07219-7