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Open Access 01-12-2013 | Research article

Appendicitis: What does really make the difference between private and public hospitals?

Authors: Milton Steinman, Patrícia S Rogeri, Lia L Lenci, Clara C Kirschner, José Carlos Teixeira, Paulo David S Gonçalves, Nelson Akamine, Silvio Possa

Published in: BMC Emergency Medicine | Issue 1/2013

Abstract

Background

Appendicitis is one of the most common surgical emergencies and is also a time-sensitive condition. Delays in treatment increase the risk of appendiceal perforation (AP), and thus AP rates have been used as a proxy to measure access to surgical care. It is very well known that in Brazil there are big differences between the public and private healthcare systems. Those differences can reflect in the treatment of what are considered simple cases, like appendicitis. As far as we know, it has no known links to behavioral or social risk factors, and has only one treatment option – appendectomy. The purpose of this study was to compare treatment received by Brazilian people, both by those who depend on the public and private healthcare system, and how it affects their outcome.

Methods

Data was collected from the records of all patients submitted to appendectomy, in a public and in a private Sao Paulo city’s hospitals, during January to April of 2010.

Results

Patients admitted by the public hospital present symptoms for a longer period of time than those treated by the private one. It took a significantly higher amount of time for the patients from the public hospital undergo surgery, and their length of stay is also significantly higher.

Conclusions

Appendicitis in a public scenario is associated with increased time from onset of symptoms to operative intervention and the main reason is the delayed presentation. Clinical polices for abdominal pain should be instituted by the public healthcare system, based on population education, healthcare professionals training and establishment of strategies that can speed the diagnosis process up.

Nwomeh BC, Chisolm DJ, Caniano DA, Kelleher KJ: Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem?. Pediatrics. 2006, 117 (3): 870-875. 10.1542/peds.2005-1123.CrossRefPubMed

Kagamimori S, Gaina A, Nasermoaddeli A: Socioeconomic status and health in the Japanese population. Soc Sci Med. 2009, 68 (12): 2152-2160. 10.1016/j.socscimed.2009.03.030.CrossRefPubMed

Houweling TA, Kunst AE: Socio-economic inequalities in childhood mortality in low- and middle-income countries: a review of the international evidence. Br Med Bull. 2010, 93: 7-26. 10.1093/bmb/ldp048.CrossRefPubMed

Barros FC, Victoria CG, Scherpbier R, Gwatkin D: Socioeconomic inequities in the health and nutrition of children in low/middle income countries. Rev Saude Publica. 2010, 44 (1): 1-16. 10.1590/S0034-89102010000100001.CrossRefPubMed

Gustafsson-Wright E, Janssens W, van der Gaag J: The inequitable impact of health shocks on the uninsured in Namibia. Health Policy Plan. 2011, 26 (2): 142-156. 10.1093/heapol/czq029.CrossRefPubMed

Devlin RA, Sarma S, Zhang Q: The role of supplemental coverage in a universal health insurance system: some Canadian evidence. Health Policy. 2011, 100 (1): 81-90. 10.1016/j.healthpol.2010.08.011.CrossRefPubMed

To T, Langer LC: Does access to care affect outcomes of appendicitis in children? – A population-based cohort study. BMC Health Serv Res. 2010, 25: 250-CrossRef

Malon A, Deschamps V, Salanave B, Vernay M, Szego E, Estaquio C, Kesse-Guyot E, Hercberg S, Castetbon K: Compliance with French nutrition and health program recommendations is strongly associated with socioeconomic characteristics in the general adult population. J Am Diet Assoc. 2010, 110 (6): 848-856. 10.1016/j.jada.2010.03.027.CrossRefPubMed

Zimmermann PG: Is it appendicitis?. Am J Nurs. 2008, 108 (9): 27-31. 10.1097/01.NAJ.0000334971.44242.7b.CrossRefPubMed

10.

Qureshi A, Smith A, Wright F, Brenneman F, Rizoli S, Hsieh T, Tien HC: The impact of an acute care emergency surgical service on timely surgical decision-making and emergency department overcrowding. J Am Coll Surg. 2011, 213 (2): 284-293. 10.1016/j.jamcollsurg.2011.04.020.CrossRefPubMed

11.

Krajewski SA, Hameed SM, Smink DS, Rogers SO: Access to emergency operative care: a comparative study between the Canadian and American health care systems. Surgery. 2009, 146 (2): 300-307. 10.1016/j.surg.2009.04.005.CrossRefPubMed

12.

McCollum L, Pincus T: A biopsychosocial model to complement a biomedical model: patient questionnaire data and socioeconomic status usually are more significant than laboratory tests and imaging studies in prognosis of rheumatoid arthritis. Rheum Dis Clin North Am. 2009, 35 (4): 699-712. 10.1016/j.rdc.2009.10.003.CrossRefPubMed

13.

Lee SL, Shekherdimian S, Chiu VY, Sydorak RM: Perforated appendicitis in children: equal access to care eliminates racial and socioeconomic disparities. J Pediatr Surg. 2010, 45 (6): 1203-1207. 10.1016/j.jpedsurg.2010.02.089.CrossRefPubMed

14.

Lee SL, Shekherdimian S, Chiu VY: Effect of race and socioeconomic status in the treatment of appendicitis in patients with equal health care access. Arch Surg. 2011, 146 (2): 156-161. 10.1001/archsurg.2010.328.CrossRefPubMed

15.

Kalliakmanis V, Pikoulis E, Karavokyros IG, Felekouras E, Morfaki P, Haralambopoulou G, Panogiorgou T, Gougoudi E, Diamantis T, Leppaniemi A, Tsigris C: Acute appendicitis: the reliability of diagnosis by clinical assessment alone. Scand J Surg. 2005, 94 (3): 201-206.PubMed

16.

Stromberg C, Johansson G, Adolfsson A: Acute abdominal pain: diagnostic impact of immediate CT scanning. World J Surg. 2007, 31 (12): 2347-2354. 10.1007/s00268-007-9233-x.CrossRefPubMed

17.

Stengel JW, Webb EM, Poder L, Yeh BM, Smith-Bindman R, Coakley FV: Acute appendicitis: clinical outcome in patients with an initial false-positive CT diagnosis. Radiology. 2010, 256 (1): 119-126. 10.1148/radiol.10091229.CrossRefPubMed

18.

Alvarado A: A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986, 15 (5): 557-586. 10.1016/S0196-0644(86)80993-3.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-227X/13/15/prepub

Title: Appendicitis: What does really make the difference between private and public hospitals?
Authors: Milton Steinman
Patrícia S Rogeri
Lia L Lenci
Clara C Kirschner
José Carlos Teixeira
Paulo David S Gonçalves
Nelson Akamine
Silvio Possa
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Emergency Medicine / Issue 1/2013
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/1471-227X-13-15

At a glance: The STEP trials

Springer Medicine

Appendicitis: What does really make the difference between private and public hospitals?

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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