Demographic factors associated with length of stay in hospital and histological diagnosis in adults undergoing appendicectomy
Shivam Bhanderi1, Quratul Ain1, Iram Siddique1, Vasileios Charalampakis2, Markos Daskalakis1, Rajwinder Nijjar1, Martin Richardson1, Rishi Singhal1
1Department of General Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
2Clinic of General Surgery, Warwick Hospital South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
Objective: Appendicectomy remains of the most common emergency operations in the United Kingdom. The exact etiologies of appendicitis remain unclear with only potential causes suggested in the literature. Social deprivation and ethnicity have both been demonstrated to influence outcomes following many operations. There are currently no studies evaluating their roles with regards to severity and outcomes following appendicectomy.
Material and Methods: Demographic data were retrieved from health records for adult patients who underwent appendicectomy between 2010-2016 within a single NHS trust. To measure social deprivation, Indices of Multiple Deprivation (IMD) rankings were used. Histology reports were reviewed and diagnosis classified into predefined categories: non-inflamed appendix, uncomplicated appendicitis, complicated appendicitis and gangrenous appendicitis.
Results: Three thousand four hundred and forty-four patients were identified. Mean age was 37.8 years (range 73 years). Using a generalized linear model, South Asian ethnicity specifically was found to be independently predictive of increased length of stay following appendicectomy (p< 0.001). Amongst South Asian patients, social deprivation was found to be further predictive of longer hospital stay (p= 0.005). Deprivation was found to be a predictor of complicated appendicitis but not of gangrenous appendicitis (p= 0.01). Male gender and age were also independent predictors of positive histology for appendicitis (p< 0.001 and p= 0.021 respectively).
Conclusion: This study is the first to report an independent association between South Asian ethnicity and increased length of stay for patients undergoing appendicectomy in a single NHS trust. The associations reported in this study may be a result of differences in the pathophysiology of acute appendicitis or represent inequalities in healthcare provision across ethnic and socioeconomic groups.
Keywords: Appendicitis, general surgery, deprivation, ethnicity
Cite this article as: Bhanderi S, Ain Q, Siddique I, Charalampakis V, Daskalakis M, Nijjar R, et al. Demographic factors associated with length of stay in hospital and histological diagnosis in adults undergoing appendicectomy. Turk J Surg 2022; 38 (1): 36-45.
According to the results of the decision tool of NHS Health Research Authority and UK RI Medical Research Council, it is no need to have NHS REC review for this study.
Concept - RS; Design - SB, QA; Supervision - RS; Materials - RS; Data Collection and/or Processing - SB, QA, IS; Analysis and/or Interpretation - SB; Literature Search - SB, QA; Writing Manuscript - SB, QA; Critical Reviews -SB, QA, VS, MD, RN, MR, RS.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.