ArticleWorld journal of surgery2018
Appendicitis: Rural Patient Status is Associated with Increased Duration of Prehospital Symptoms and Worse Outcomes in High- and Low-Middle-Income Countries.
Article in World journal of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 35 citations in OpenAlex.
- Trends in the global burden of appendicitis in children at global, regional, and national levels: An analysis using GBD 2021 data.The Journal of the Egyptian Public Health Association · 2026Article
- Outcomes of Antibiotic-Only Management Versus Appendectomy for Acute Appendicitis in a Low Resource Setting.World journal of surgery · 2026Article
- Article
- Barriers to accessing appendectomy in the public sector health system in the Western Cape Province, South Africa.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Outcome of Laparoscopic Appendectomy: A Retrospective Study From a Local Secondary Referral Hospital.Cureus · 2024Article
- Factors Contributing to Delays to Accessing Appendectomy in Low- and Middle-Income Countries: A Scoping Review.World journal of surgery · 2023Article
- The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study.Surgery in practice and science · 2023Article
- Feasibility and acceptability of mobile phone-based triage tool to identify discharged trauma patients in need of further care in Cameroon.Trauma surgery & acute care open · 2023Article
- Predictors and management outcomes of perforated appendicitis in sub-Saharan African countries: A retrospective cohort study.Annals of medicine and surgery (2012) · 2022Article
- Trends in Adoption of Laparoscopic Appendicectomy in a Developing Country: Closing the Gap.World journal of surgery · 2022Article
- Geographic Variation in Appendiceal Perforation Rates in Canada: a Population-Based Cohort Study.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2020Article
- Soft Tissue Sepsis Places a Massive Burden on Regional and Tertiary Surgical Services in KZN Province South Africa.World journal of surgery · 2020Article
- Nationwide study of appendicitis in children.The British journal of surgery · 2019Article
- The Operative Output of District Hospitals in KwaZulu-Natal Province is Heavily Skewed Toward Obstetrical Care.World journal of surgery · 2019Article
- Clinical Outcomes and Healthcare Costs Associated with Laparoscopic Appendectomy in a Middle-Income Country with Universal Health Coverage.World journal of surgery · 2019Article
- Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study.World journal of surgery · 2018Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAppendicitis is a significant economic and healthcare burden in low-, middle-, and high-income countries. We aimed to determine whether urban and rural patient status would affect outcomes in appendicitis in a combined population regardless of country of economic status. We hypothesize that patients from rural areas and both high- and low-middle-income countries would have disproportionate outcomes and duration of symptoms compared to their urban counterparts.
methodsAdults (≥18 years) with appendicitis during 2010-2016 in South Africa and USA were reviewed using multi-institutional data. Baseline demographic, operative details, durations of stay, and complications (Clavien-Dindo index) were collected. AAST grades were assigned by two independent reviewers based on operative findings. Summary, univariate, and multivariable analyses of rural and urban patients in both countries were performed.
resultsThere were 2602 patients with a median interquartile range [IQR] of 26 [18-40] years; 45% were female. Initial management included McBurney incisions (n = 458, 18%), laparotomy (n = 915, 35%), laparoscopic appendectomy (n = 1185, 45%), and laparoscopy converted to laparotomy (n = 44, 2%). Comparing rural versus urban patient status, there were increased overall median [IQR] AAST grades (3 [1-5] vs. 2 [1-3], p = 0.001), prehospital duration of symptoms (2 [1-5] vs. 2 [1-3], p = 0.001), complications (44.3 vs. 23%, p = 0.001), and need for temporary abdominal closure (20.3 vs. 6.9%, p = 0.001).
conclusionDespite socioeconomic status and country of origin, patients from more rural environments demonstrate poorer outcomes notwithstanding significant differences in overall disease severity. The AAST grading system may serve a potential benchmark to recognize areas with disparate disease burdens. This information could be used for strategic improvements for surgeon placement and availability.
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