Comparison of Appendicitis Outcomes Between Teaching and Nonteaching Hospitals in Salah Al-Deen Province, Iraq

Abstract

Background: Appendicitis is one of the most common surgical emergencies
encountered by surgeons, and appendectomy is the most common surgical
emergency operation done by general surgeons. At the teaching hespital, the
surgical residents are actively involved in all aspects of patient care including
preoperative preparation, operatively as the primary surgeon in appendectomy
and postoperative follow up. Senior resident surgeons typically serve as teaching
assistants for the appendectomy cases under attending supervision. In contrast, no
residents are present at the nonteaching institutions, and the attending surgeon
performs all aspects of patient care.
Objectives: to determine the outcomes of appendicitis between a teaching
and nonteaching hospital, in order to document the effect of residents acting as the surgeon for a surgical procedure .
Methods: A prospective study involved all patients with acute appendicitis,
aged (10-50) years admitted either to Tikrit Teaching Hospital (TTH), or to Shirqat
General Hospital (SGH) , which is nonteaching, during the period from January
2013, to June 2014. Patient's factors including: age, gender, and the presence of
perforation were collected. Outcome variables were 30-day morbidity including
wound infection, postoperative abscess drainage, and re-admission and length of
hospitalization (LOH) recorded and compared between the two hospitals. Patients
with perforated appendicitis treated nonoperatively were excluded from the
analysis.
Results: One thousand, six hundreds, eighty-four (1684) patients were
treated at the teaching institution(TTH) with mean age was 15.6 years, 58% males,
and 738 patients at the nonteaching SGH with mean age of 17 years, 61% male.
The perforated appendicitis rate was 20.3% at the teaching institution and 19.9%
at the nonteaching institution. A 45 (13%) patients with perforated appendicitis
were successfully treated nonoperatively at TTH and 8 (5.5%) at SGH.
For nonperforated appendicitis, rates of wound infection & postoperative
abscess drainage were higher at the non teaching hospital with ( 2.7% vs.
1.8% ,and 1.3% vs. 0.6% respectively), the 30 days re-admission was higher at the
teaching institution (2.2% vs. 2.0%). LOH was shorter in the teaching institution
(1.0 € 1.4 vs. 1.8 ‡ 1.2 days). For perforated appendicitis, lower rates of wound
infection ( 10% vs. 24.4%) and abscess drainage (9.8% vs.11.5%) at TTH. The
LOH is shorter at TTH(2.5 + 4.2d) vs. (3.3 5d). The 30 days re-admission is the
same (10.8%).
Conclusions: This study found that LOH was shorter in TTH than in SGH
for both perforated and non perforated appendicitis. Regarding patients with
perforated appendicitis, there was a lower rate of wound infection, with a higher
percentage for those who were successfully treated non-operatively. So, the
presence of surgical residents did not adversely affect the quality of care for
patients with appendicitis.