Yang Estin, Cook Colin, Kahn Delawir
Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L223, Portland, OR, 97239, USA,
World J Surg. 2015 Jul;39(7):1700-7. doi: 10.1007/s00268-015-3002-z.
South Africa has a low incidence of acute appendicitis, but poor outcomes. However, South African studies on appendicitis focus solely on public hospitals, neglecting those who utilize private facilities. This study aims to compare appendicitis characteristics and outcomes in public and private hospitals in South Africa.
A prospective cohort study was conducted among two public and three private hospitals in the Cape Town metropole, from September 2013 to March 2014. Hospital records, operative notes, and histology results were reviewed for patients undergoing appendectomy for acute appendicitis. Patients were interviewed during their hospitalization and followed up at monthly intervals until normal function was attained.
A total of 134 patients were enrolled, with 73 in the public and 61 in the private sector. Education and employment were higher among private sector patients. Public sector patients had a higher rupture rate (30.6 vs 13.2 %, p = 0.023). Times to presentation were not statistically different between the two cohorts. Public sector patients had longer hospital stays (5.3 vs 2.9 days, p = 0.036) and longer return to work times (23.0 vs 12.1 days, p < 0.0001). Although complication rates were similar, complications in public hospitals were more severe.
Public sector patients in South Africa with appendicitis have higher rupture rates, worse complications, longer hospital stays, and longer recoveries than private sector patients. Patients with perforation had longer delays in presentation than patients without perforation.
南非急性阑尾炎发病率较低，但治疗效果不佳。然而，南非关于阑尾炎的研究仅聚焦于公立医院，忽视了那些使用私立医疗机构的患者。本研究旨在比较南非公立医院和私立医院阑尾炎的特征及治疗效果。
2013年9月至2014年3月，在开普敦大都市的两家公立医院和三家私立医院开展了一项前瞻性队列研究。对因急性阑尾炎接受阑尾切除术的患者的医院记录、手术记录和组织学结果进行了回顾。在患者住院期间进行访谈，并每月随访一次，直至其功能恢复正常。
共纳入134例患者，其中公立医院73例，私立医院61例。私立医院患者的教育程度和就业率更高。公立医院患者的阑尾破裂率更高（30.6%对13.2%，p = 0.023）。两组患者的就诊时间无统计学差异。公立医院患者的住院时间更长（5.3天对2.9天，p = 0.036），恢复工作的时间更长（23.0天对12.1天，p < 0.0001）。虽然并发症发生率相似，但公立医院的并发症更严重。
南非公立医院阑尾炎患者比私立医院患者的阑尾破裂率更高、并发症更严重、住院时间更长且恢复时间更长。穿孔患者的就诊延迟时间比未穿孔患者更长。
