The impact of regional reconfiguration on the management of appendicitis

Background Reconfiguration of surgical services in the Mid-West in 2009 resulted in a large increase in numbers of patients undergoing emergency surgery for appendicitis in University Hospital Limerick (UHL). Aims The aim of this study was to assess the impact of reconfiguration on the management of...

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Published in:	Irish journal of medical science Vol. 183; no. 3; pp. 351 - 355
Main Authors:	Healy, D. A., McCartan, D. P., Grace, P. A., Aziz, A., Dermody, F., Clarke Moloney, M., Coffey, J. C., Walsh, S. R., Burke, P. E.
Format:	Journal Article
Language:	English
Published:	London Springer London 01-09-2014
Subjects:	Acute Disease Adolescent Adult Aged Appendectomy - statistics & numerical data Appendicitis - surgery Emergency Service, Hospital - organization & administration Family Medicine Female General Practice Hospitals, High-Volume Hospitals, University - organization & administration Humans Internal Medicine Laparoscopy - methods Laparoscopy - statistics & numerical data Length of Stay Male Medicine Medicine & Public Health Middle Aged Models, Organizational Original Article Workload Appendectomy Laparoscopy Emergency Appendicitis Appendicectomy Reconfiguration
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Summary:	Background Reconfiguration of surgical services in the Mid-West in 2009 resulted in a large increase in numbers of patients undergoing emergency surgery for appendicitis in University Hospital Limerick (UHL). Aims The aim of this study was to assess the impact of reconfiguration on the management of appendicitis in this area. Methods Data on all patients who underwent appendicectomy between January and June 2007 were compared with the corresponding data from January to June 2011. The numbers of operations, types of operations, lengths of stay (LOS), operation start times, rates of negative histology specimens and readmissions within 30 days were compared. One hundred and twenty-five appendicectomies [48 laparoscopic (38.4 %)] were performed in the 2007 group of which 32 specimens (25.6 %) were histologically negative. Three hundred and nineteen appendicectomies [238 laparoscopic (74.6 %)] were performed in the 2011 group of which 62 specimens (19.4 %) were histologically negative. The increase in numbers of laparoscopic procedures was significant ( p < 0.001). The reduction in the negative appendicectomy rate was not statistically significant ( p = 0.16). There were 10 conversions (20.8 %) to open surgery in the 2007 period and 12 (5 %) in the 2011 period ( p = 0.001). Mean LOS for the 2007 and 2011 groups was 4.45 and 3.16 days ( p < 0.001). Six (4.8 %) readmissions within 30 days occurred in the 2007 group with 20 (6.3 %) in the 2011 group ( p = 0.66). Conclusion Though reconfiguration of surgical services has resulted in a significant increase in workload, LOS has decreased significantly while maintaining acceptably low negative appendicectomy, conversion and readmission rates.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0021-1265 1863-4362
DOI:	10.1007/s11845-013-1015-x