Audit to evaluate the clinical presentation and surgical management of acute appendicitis at a secondary-level hospital in the Western Cape

Abstract

Background: Acute appendicitis is a frequent cause of abdominal emergencies, with delayed presentation and diagnosis increasing the risk of perforation and postoperative morbidity. In South Africa, the accessibility to healthcare and referral to surgical services can impact patient outcomes.

Methods: All patients treated for acute appendicitis at George Regional Hospital during the period January 2024 – December 2024 (1 year) were included in the study. Patients who were admitted with acute appendicitis but discharged with an alternative diagnosis were excluded.

Results: The sample consisted of 218 patients. The majority (88.5%) underwent surgical management, with the remainder managed conservatively. Patients referred from district hospitals had a significantly higher rate of perforated appendicitis compared to local patients (57.9% vs 40.2%, p = 0.014). Delayed presentation with symptoms beyond 72 hours was strongly associated with perforation (IQR 2.0–4.5; p = 0.034). Laparoscopic appendicectomy was performed in 66.3% of cases, with a 20.3% conversion rate to open surgery, predominantly in cases of perforation. The median length of stay was longer in patients with perforated appendicitis (IQR 3–6 days; p < 0.001). No in-hospital mortality was observed.

Conclusions: Delayed presentation was significantly associated with a higher risk of perforated appendicitis and greater operative complexity. Patients referred from district hospitals experienced higher rates of perforation likely due to delays in recognition, referral, and access to surgical care. Improving early diagnosis and streamlining referral pathways may reduce the incidence of complicated appendicitis and improve patient outcomes in our region.