Abstract
OBJECTIVE: To compare outcomes of appendectomies performed in rural hospitals by specialist surgeons and GP surgeons. DESIGN: Retrospective analysis of the Canadian Institute for Health Information's (CIHI) Discharge Abstract Database (DAD) 1996-1999. SETTING: Rural hospitals in Ontario, Saskatchewan, Alberta, and British Columbia. PARTICIPANTS: All surgeons who performed appendectomies in these hospitals during the study period. MAIN OUTCOME MEASURES: Mortality; diagnostic accuracy, perforation, and repeat laparotomy rates; length of stay; and need for transfer to another acute-care institution. RESULTS: Specialist surgeons performed 3624 appendectomies; GP surgeons performed 963. Rates of comorbidity, diagnostic accuracy, and transfer, and mean lengths of stay were similar for patients of GP and specialist surgeons. Patients operated on by specialists were older and more likely to have perforations and to require second intra-abdominal or pelvic procedures. Triage to a specialist, older age, and comorbidity all independently predicted perforation. Only perforation predicted a second intra-abdominal or pelvic procedure. CONCLUSION: Appendectomy is a safe procedure in rural hospitals, whether performed by specialist or GP surgeons. Some difficult cases are routinely referred to specialists.
Full Text
The Full Text of this article is available as a PDF (190.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Berry J., Jr, Malt R. A. Appendicitis near its centenary. Ann Surg. 1984 Nov;200(5):567–575. doi: 10.1097/00000658-198411000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hawker G. A., Coyte P. C., Wright J. G., Paul J. E., Bombardier C. Accuracy of administrative data for assessing outcomes after knee replacement surgery. J Clin Epidemiol. 1997 Mar;50(3):265–273. doi: 10.1016/s0895-4356(96)00368-x. [DOI] [PubMed] [Google Scholar]
- Humphries K. H., Rankin J. M., Carere R. G., Buller C. E., Kiely F. M., Spinelli J. J. Co-morbidity data in outcomes research: are clinical data derived from administrative databases a reliable alternative to chart review? J Clin Epidemiol. 2000 Apr;53(4):343–349. doi: 10.1016/s0895-4356(99)00188-2. [DOI] [PubMed] [Google Scholar]
- Inglis F. G. The community general surgeon: a time for renaissance. Can J Surg. 1995 Apr;38(2):123–129. [PubMed] [Google Scholar]
- Kandel G. Helicobacter and disease: still more questions than answers. Can J Surg. 2000 Oct;43(5):339–346. [PMC free article] [PubMed] [Google Scholar]
- Levy A. R., Tamblyn R. M., Fitchett D., McLeod P. J., Hanley J. A. Coding accuracy of hospital discharge data for elderly survivors of myocardial infarction. Can J Cardiol. 1999 Nov;15(11):1277–1282. [PubMed] [Google Scholar]
- Ricci M. A., Trevisani M. F., Beck W. C. Acute appendicitis. A 5-year review. Am Surg. 1991 May;57(5):301–305. [PubMed] [Google Scholar]
- Walker S. J., West C. R., Colmer M. R. Acute appendicitis: does removal of a normal appendix matter, what is the value of diagnostic accuracy and is surgical delay important? Ann R Coll Surg Engl. 1995 Sep;77(5):358–363. [PMC free article] [PubMed] [Google Scholar]
- Wen S. W., Naylor C. D. Diagnostic accuracy and short-term surgical outcomes in cases of suspected acute appendicitis. CMAJ. 1995 May 15;152(10):1617–1626. [PMC free article] [PubMed] [Google Scholar]