Pre-hospital management and patient-related factors affecting access to the surgical care of appendicitis – a survey study

Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, <i>p</i> &lt; .001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor’s visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40–64 years (OR 1.63 (95% CI 1.06–2.52); compared to age 18–39), age more than 64 years (OR 2.84 (95% CI 1.18–6.80); compared to age 18–39), loss of appetite (OR 2.86 (95% CI 1.64–4.98)), fever (OR 1.66 (95% CI 1.08–2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15–3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32–3.53)). Age 40–64 years (OR 2.41 (95% CI 1.50–3.88)), age more than 64 years (OR 8.79 (95% CI 2.19–35.36)), fever (OR 1.83 (95% CI 1.15–2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14–3.14)) were also risk factors for complicated appendicitis. Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis.

院前延误（pre-hospital delay）时长过长会显著提升穿孔性阑尾炎（perforated appendicitis）的发生风险。本研究旨在探究影响该延误的患者相关因素。研究针对急性阑尾炎（acute appendicitis）阑尾切除术（appendectomy）后患者开展调查，向参与者询问了其前往手术中心的就诊路径与社会经济状况（socioeconomic status），并对影响延误时长及复杂性阑尾炎（complicated appendicitis）发生率的相关变量进行了分析。本研究共纳入510例患者，其中157例（31%）为复杂性阑尾炎患者，其院前延误时长的中位数为42小时；无并发症阑尾炎患者的延误时长为21小时，p < 0.001。46例（29%）复杂性阑尾炎患者在首次就诊后未被转诊至医院。多因素分析（multivariate analysis）结果显示，以18~39岁年龄段为参照，40~64岁(优势比(odds ratio, OR)=1.63，95%置信区间(confidence interval, CI)=1.06~2.52)、64岁以上(OR=2.84，95%CI=1.18~6.80)年龄段，食欲减退(OR=2.86，95%CI=1.64~4.98)、发热(OR=1.66，95%CI=1.08~2.57)、热线护士未予转诊(OR=2.02，95%CI=1.15~3.53)以及首诊未予转诊(OR=2.16，95%CI=1.32~3.53)均与较长院前延误显著相关。此外，40~64岁(OR=2.41，95%CI=1.50~3.88)、64岁以上(OR=8.79，95%CI=2.19~35.36)、发热(OR=1.83，95%CI=1.15~2.89)以及首诊未予转诊(OR=1.90，95%CI=1.14~3.14)同样为复杂性阑尾炎的危险因素。高龄、发热以及基层医疗中未能疑似诊断急性阑尾炎，均与延长的院前延误及复杂性阑尾炎相关。