A new global study into appendicitis has found that there are major inequalities in care, with some countries having little access to CT imaging or minimally invasive surgery - resulting in poorer patient outcomes.
Published in the Lancet Global Health, the Appendicitis Global Outcomes Study (AlliGatOr) study found that delays in accessing surgical assessment for suspected appendicitis are associated with a significantly higher risk of life-threatening complications.
Led by University of Birmingham researchers, the international study analysed data from more than 45,000 patients across 112 countries - providing new insights into when delays matter most in this common emergency condition.
The study - which is the largest prospective global study of appendicitis ever conducted - found that the longer patients waited before being assessed by a surgeon, the higher their risk of perforation. Rates rose progressively from around 23% in patients assessed within 12 hours, to 48% in those waiting more than 72 hours.
Appendicitis is the most common abdominal surgical emergency worldwide. If left untreated, it can lead to perforation (a burst appendix), which is associated with an increased risk of complications such as longer hospital stays or infections.
Dr Dmitri Nepogodiev, from the University of Birmingham and senior lead author of the study, said: "Appendicitis surgery is a key focus for global surgical improvements, as it is one of the most common emergency surgeries and has significant consequences for patients. We are very grateful for the many thousands of patients who consented to take part in the largest study of its kind.
"These findings suggest that getting patients to surgical assessment within 24 hours of symptom onset should be a key target for healthcare systems worldwide in order to improve both patient outcomes and experiences."
Global inequalities across patient care
The research team worked across countries around the world and measured two important and different types of delay that affect patient care. By comparing pre-hospital delay, which time from symptom onset to first surgical assessment; with In-hospital delay, which is time from assessment to surgery; the team looked at the most significant influence on health complications.
While longer pre-hospital delays were linked to worse outcomes, the study found that short delays inside hospital did not increase the risk of perforation.
The study also highlights major global inequalities in access to diagnosis and treatment:
- Access to CT scans ranged from 58.6% in high-income countries to just 5.6% in low-income countries
- Use of minimally invasive surgery dropped from 95.8% to 7.3% across the same groups
These disparities in resources may contribute to poorer outcomes in lower-income settings, despite similar patterns of presentation.
Theophilus Anyomih, a PhD researcher at the University of Birmingham and first author of the study, said: "These findings demonstrate the need for targeted investments that would make a significant difference for large numbers of patients around the world. Our study emphasies the critical importance of reducing the time that patients wait to get to hospital, both in building capacity in healthcare systems and through public health education.
"Additionally, the study also highlights equity gaps in healthcare systems around the world - where in some cases only around one in 20 patients have potential access to benefit from healthcare advancements such as CT scanning."
The research team recommend that two key priorities for improving outcomes:
- Earlier access to surgical assessment, including improving referral pathway and increasing public awareness of symptoms; and
- Stronger diagnostic capacity, including expanding access to imaging such as CT scans and the appropriate use of minimally invasive surgery
The research was conducted through the AlliGatOr (Appendicitis Global Outcomes) Collaborative, coordinated by the NIHR Global Health Research Unit on Global Surgery at the University of Birmingham.
