Randall Zuckerman, MD, of North Country Surgical Associates in Newport, Vermont, recently co-authored an article that will be published in Annals of Surgery. The title of the article is “Perforated Appendicitis among Rural and Urban Patients: Implications of Access to Care.” I reports on the study conducted to determine whether rural patients are more likely to present with perforated appendicitis compared with urban patients.
The Annals of Surgery is a monthly review of surgical science. Published since 1885, it is the world's most highly referenced surgery journal, providing the international medical community with information on significant contributions to the advancement of surgical science and practice. Surgeons look to Annals of Surgery first for innovations in practice and technique.
According to Dr. Zuckerman’s article, perforated appendicitis has historically been associated with overweight patients, length of hospital stay, and overall health care costs. Recent arguments suggest that high rates of ruptured appendices may be rather associated with inadequate access to surgical care.
The authors performed a retrospective study of 122,990 patients with acute appendicitis from the Nationwide Inpatient Sample from 2003 to 2004. The patient data was studied to determine appendiceal perforation, rural versus urban status, as well as patient and hospital factors associated with perforation.
Overall, 32.07% of patients presented with perforation. Rural patients were more likely than urban patients to present with perforation (35.76% vs. 31.48%). Thirty percent of rural patients were treated in urban hospitals. Rural patients treated at urban hospitals were more likely to present with perforation compared with rural patients treated at rural hospitals.
The article concludes that patients from rural areas have higher rates of perforation with acute appendicitis than urban patients. This difference persists when accounting for other factors associated with perforation. These differences in perforation rates suggest disparities in access to timely surgical care.