Abstract
Background: On January 1st, 2011, the catchment area of Akershus University Hospital was increased by 160000 inhabitants. Acute appendicitis is a common surgical emergency. The aim of the present study was to investigate if the increase in catchment area affected the quality of treatment for patients undergoing surgery for suspected acute appendicitis by studying this patient group in three periods; one year before, immediately after, and one year after the change in catchment area took place. Materials and methods: A retrospective study was performed. The medical records of three sets of 100 patients each who consecutively underwent surgery for suspected acute appendicitis in the periods starting January 1st, 2010, - 2011 and - 2012 respectively. The data collected were: Age, sex, ASA-classification, supplementary diagnostic investigations, preoperative waiting time, type of surgery performed, final diagnose, complications, postoperative hospital stay, and further contact with the hospital after discharge. Results: The proportion of patients with perforated appendicitis increased from 13 % to 28 % from 2010 to 2012 (p = 0.009). For patients with confirmed acute appendicitis, the proportion with postoperative hospital stay of more than four days increased in 2012 (p = 0.044). Although not significant, the median age and proportion of male patients were higher in 2012 than in the two previous periods. Logistic regression confirmed that age over 50 years and having surgery for suspected appendicitis in 2012 were significantly associated with perforation. The variations in preoperative waiting time, serious complications and further hospitalizations between the three periods were not statistically significant. Interpretation: No difference in quality of treatment was detected. The increased proportion of perforated appendicitis in 2012 can partly be explained by increased median age and an increased proportion of male patients in 2012, compared to 2010 and 2011.