Appendicitis in Far North Queensland: a new take on an old story

Abstract

Background Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). Methods Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012–2018. Population data for the same time period provided rates. Results Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re‐admission rate was 3.8% and all‐cause mortality was 0.03%. Conclusion The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non‐Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.

Impact of socioeconomic status and road distance to hospital on perforated appendicitis rates at a large rural referral centre

“…In one epidemiological study, it was demonstrated that Indigenous patients with appendicitis had higher ICU admission rates and longer inpatient stays compared to non-Indigenous patients. 15 However, the study was purely descriptive and did not examine how differences in socioeconomic status and distance from hospital between the two groups could account for this disparity. Increased distance from hospital was shown to increase the length of stay for both Indigenous and non-Indigenous patients.…”

“…The extent to which socioeconomic status and distance from hospital play a role in this disparity is unclear. In one epidemiological study, it was demonstrated that Indigenous patients with appendicitis had higher ICU admission rates and longer inpatient stays compared to non‐Indigenous patients 15 . However, the study was purely descriptive and did not examine how differences in socioeconomic status and distance from hospital between the two groups could account for this disparity.…”

The provision of general surgery in rural Australia: a narrative review

“…55 Furthermore, both appendicectomy and paediatric surgical outcomes in rural northern Australia were equivalent to national outcomes. 56,57 Two retrospective studies reported no significant difference in post-operative pancreaticoduodenectomy or gastrectomy mortality in rural compared with metropolitan centres, despite only 7.4% of pancreaticoduodenectomies and 3.8% of gastrectomies being done rurally. 58,59 In Townsville, after introduction of a specialised hepatobiliary unit, there were no Narrative reviews significant differences in operative approach or complexity, nor in mortality or complication rates between the two periods (ie, before and after the specialised hepatobiliary service).…”

“…A 2018 study explored mortality after emergency abdominal surgery in a cohort of 237 patients over five years in Mount Gambier (RA2) and found that emergency laparotomy mortality rates were better than published international rates 55 . Furthermore, both appendicectomy and paediatric surgical outcomes in rural northern Australia were equivalent to national outcomes 56,57 …”