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Management of appendicitis in rural New Zealand – a multicentre study of provincial South Island hospitals

A 2019/2020 Summer Studentship research project

The results would likely influence policy decisions around the ongoing provision of surgical services in provincial regions of NZ in the face of ever-increasing centralisation and subspecialisation of health care and have the potential to confer benefit upon the residents and potential residents of the rural Canterbury.

Student: Nicole Withers
Supervisors: Mr Tim Eglinton, Head of Department of Surgery, University of Otago, Christchurch Hospital, Dr Magda Sakowska, General Surgeon, Timaru Hospital, South Canterbury DHB
Sponsor: McKenzie Charitable Foundation

Introduction

Appendicitis is the most common abdominal surgical emergency for those admitted acutely with abdominal pain. Although studies are emerging internationally on non-operative management, surgery still remains the standard of treatment in NZ. Given the prevalence of appendicitis, many surgical units have used appendicectomy as a quality measure of timely delivery of emergency surgical services. Dedicated emergency surgical units in metropolitan hospitals have improved patient flow and access to timely preopeartive imaging as well as access to emergency operating theatres.

This has resulted in improved access to treatment for city dwellers but little is known about the provision of appendicectomy in NZ rural regions. No dedicated emergency surgical units exist in provincial hospitals, there is no dedicated emergency theatre and on-call surgeons, if available, manage emergency patient care around daytime elective commitments. Where surgeons are not available, like Ashburton and Kaikoura hospitals, patients will be transferred to a nearby hospital (Christchurch). This undoubtedly increases the wait-times for treatment as delays are encountered at every aspect of inter-hospital transfers. Recent research from Wellington hospital, shows that patients who present directly to a tertiary centre can expect to wait about 18 hours for surgery once the decision to operate has been made for patients suffering from appendicitis. There is a paucity of rural surgical research and it is not known if patients in rural regions of NZ, who face inter-hospital transfers to have surgery, face longer wait times leading to potentially poorer clinical outcomes.

Aim

To assess the treatment of appendicitis in patients who live in medically remote regions (Ashburton and Kaikoura); medically remote meaning that although patients can be admitted to these regional hospitals for work up of emergency conditions, surgery can only be offered elsewhere. To compare these results to those presenting directly to Christchurch Hospital.

Method

The study will involve looking at electronic health records (EHR) of patients presenting with appendicitis over a 5-year time frame to Christchurch Hospital as well as Ashburton and Kaikoura hospitals – this will use existing databases to recall numbers. The EHR and paper records would be retrospectively analysed for patient demographics, workup, times to presentation, imaging and theatre access, as well as post-operative outcomes.

Student researcher’s component of the study

The database is already established in terms of data to be collated as there is data from a pilot study looking at access to treatment for acute appendicitis in three rural NZ hospitals (Timaru/West Coast/Wairau). The supervisors will provide help in accessing the patient records, interpreting ambiguities in results and be involved in submitting the final research for publication.

Student Prerequisites

Medical student best suited especially if interested in rural medicine/surgery

How to apply

Email tim.eglinton@cdhb.health.nz