Abstract

Appendicectomy for appendicitisremains the second most common urgent gastrointestinal surgery in the United Statesand one of the most common worldwide [1, 2]. Low socioeconomic status and a lack of private health insurance have been shown to have detrimental effects on the prognosis of patients with appendicitis [3-7]. Such patients experience higher rates of appendiceal perforation, which increases morbidity 10-fold. [8, 9]. They also attend hospital later, have reduced access to laparoscopic surgery and confront extended hospital stays and prolonged periods absent from work [3-7]. Private hospital emergency departments have helped offset the healthcare burden on public hospital emergency departments worldwide[10]. Patients presenting to private hospitals have the luxury of choosing and having better access to their treating surgeon and generally have access to a better-funded system of care. Previously it has been hypothesized that this will expedite diagnosis and therefore definitive care for conditions such as appendicitis through surgery[11]. Furthermore, privately-treated patients will more likely be operated upon by a specialist surgeon with more advanced equipment [4, 8, 11]. We set out to test whether these perceived advantages play out in reality. The primary aim of this systematic review was to compare the outcomes of patients admitted to public and private hospitals with appendicitis. The secondary aims were to compare the patient characteristics and operative details, such as access to laparoscopic surgery, of these two patient groups.