Treatment of acute appendicitis in France by type of hospital: Patient profiles are different but practices and results are the same, a prospective cohort study of 1241 patients

Le résumé fourni par la source

In this prospective observational study we compared patient characteristics, surgical practices and results, according to the type of hospital to which patients with acute appendicitis were admitted. We extracted data concerning all adults in the French Surgical Association's Multicenter register of patients admitted to emergency or surgical units for acute appendicitis (APPEA) over 4 months in 2016. The APPEA database included 1241 adults. 806 patients (64.9%) were admitted to a University Hospital (UH), 337 (27.2%) to a Regional Hospital (RH) and 98 (7.9%) to Private Clinics (PC). RH admitted significantly older patients (median age 35 [25–53], p=.008) and a higher percentage of obese patients (55 (17.9%) p< .001) than UH (median age 30 [23–45], BMI ≥30: 54 (8.4%)) and PC (median age 33.5 [24–54], BMI ≥30: 9 (10.7%)). Only 17 (1.4%) patients underwent surgery without any preoperative imaging examination. Laparoscopy was significantly more frequent in PC (94.9%) and UH (94.2%) than in RH (86.9%) (p ≤ 0.001). Thirty-day overall mortality (0.24%)) and morbidity (8.2%) were not significantly related to the type of hospital. The median length of hospital stay was longer in RH than in UH: 69 h [45–106] vs 48 [24–96] respectively, (p ≤ 0.001). We observed a significant difference in the characteristics of patients operated on for appendicitis between different types of hospital, and some low inhomogeneity of practices. Nevertheless results in terms of morbi-mortality were comparable with a low rate of morbimortality, allowing future higher proportion of outpatient procedures regardless of the type of hospital.

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