A comparative analysis of the management and outcomes of acute appendicitis in Sri Lanka and the United Kingdom

Abstract

INTRODUCTION: The aim of this study was to compare management approaches and clinical outcomes of acute appendicitis in Sri Lanka and the United Kingdom. MATERIALS AND METHODS: Data was collected prospectively from 200 patients referred to the General Surgical department with a differential diagnosis of acute appendicitis, 100 at University of Kelaniya Sri Lanka(SL group), and l 00 at University College London Hospital (UK group). RESULTS: The groups were similar with respect to age and gender Preoperative workup included ultrasound more commonly in SL patients(68% vs 34%; p<0.05), and CT more commonly in UK patients(34% vs 0%, p<0.05). More patients underwent appendicectomy in the SL group (80% vs 63%; P<0.05) , however a laparoscopic approach was utilized more often in the UK group (53.1% vs 12 5%; P<0.05). Post-operative complications were similarly represented in both groups (17.2% vs. 17.3%), but re-admission occurred with greater frequency in the UK group (7% vs. 0%; P<0.05) Histologically confirmed appendicitis was seen in a significantly greater proportion of SL patients (88.8% vs 75%, p<0.05), with no difference in the incident of perforation. Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be the only factors significantly associated with positive appendicitis difference in the incidence of perforation. Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be only factors significantly associated with Positive appendicitis. DISCUSSION: Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in Sri Lanka are more accurate and efficient in confirming appendicitis than those seen in the United Kingdom.