Appendicectomy in private practice in KwaZulu-Natal Province, South Africa

Background. The treatment of appendicitis is regarded as a bellwether procedure that can be used to describe the delivery of essential surgical care. Little has been published on clinical outcomes in the private sector in South Africa (SA), and this study attempts to address this deficiency. Objectives. To extend our understanding of the outcomes of acute appendicitis in the public and private sectors in SA. Methods. Data on patients covered by a leading medical aid who underwent appendicectomy in 26 private hospitals in Durban and Pietermaritzburg, KwaLulu-Natal Province, during the period 2010 - 2015 were obtained and compared with existing data from a recent study of patients with appendicitis treated in the Pietermaritzburg academic complex. Results. Between January 2010 and December 2015, 397 patients covered by the medical aid underwent appendicectomy in private hospitals. Their mean age was 29.7 years (range 3.7 - 87.6), the mean length of stay 4.6 days (range 1 - 41) and the mean operation time 70.6 minutes ( range 24.0 - 335.0). Of the procedures 66.5% were laparoscopic. A total of 33 patients (8.3%) required intensive care unit (ICU) admission, and 38 (9.6%) were readmitted. While there was no information on the reasons for readmission, this is a proxy marker for possible complications. The mean total event cost per patient was ZAR38 934. A total of 134 open operations were performed (33.8%). In the state sector, a total of 1 004 patients were documented. The mean patient age was 20.2 years (difference not statistically significant), mean length of stay was significantly longer at 7.3 days (p = 0.02, one-tailed t-test), and 10% of patients required ICU admission. In the state hospitals only 3% of the operations were laparoscopic. None of the private sector patients but 40% of the state patients required further surgery. Conclusions. Medical aid data provide useful information on disease profiles and outcomes in private practice. The outcome of acute appendicitis in the private sector appears to be significantly better than in the state sector. Further work is required to fully elucidate the reasons for this, although late presentation in the state patients almost certainly contributes to their poor outcome. In terms of cost, SA private practice appears to be highly efficient and is relatively inexpensive in comparison with international equivalents.