Spatial accessibility to emergency department and surgical treatment for patients with acute appendicitis in South Korea

Abstract

Background Acute appendicitis is a representative lower-risk condition requiring emergency general surgery (EGS), which has often been overlooked in terms of service and accessibility. Recent concerns regarding the delivery of surgical services in South Korea emphasize the need for close monitoring of spatial access to surgical care in patients with acute appendicitis at the regional level.Methods This study included emergency department (ED) visits with acute appendicitis and subsequent appendectomies from the National Emergency Department Information System (NEDIS) database (2015–2021). The 252 administrative districts in South Korea were classified by population density according to statistical terciles. Travel distances to the hospital were measured, and the proportion of patients admitted to regional hospitals was visualized on a geographic map. Factors related to complicated appendicitis were analyzed using logistic regression.Results Among 207,344 patients who visited the EDs, those from areas with low population density had higher proportions of patients aged ≥ 65 years (23.2%), Medical Aid recipients (4.8%), transfers from other hospitals (39.3%), and cases of complicated appendicitis (7.0%) compared to other regions. Additionally, patients in low-density regions exhibited the highest proportion of traveling 50 km or more (27.7%), compared to those in mid- (5.9%) and high-density (2.5%) regions. In the multivariate analysis, patients aged ≥ 65 years exhibited a stronger association with complicated appendicitis compared to other age groups. In some low-density regions, a significant proportion of the population traveled more than 50 km to seek surgical care despite the availability of community hospitals within the region.Conclusions The current results suggested that regions with low population density experienced low access to surgical care, revealing significant regional disparities linked to population density. Given the rapidly aging population in South Korea, urgent policy action is needed to guarantee the adequate delivery of EGS services in low-density regions.