Appendectomies in rural hospitals. Safe whether performed by specialist or GP surgeons.

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.