Background: Acute appendicitis is one of the commonest surgical emergencies in the
developed world. It naturally progresses to perforation if left untreated, which is a potentially
life-threatening condition. Surgical removal of the appendix is the definitive cure, and timely
treatment avoids preventable morbidity and mortality. Compared to the Western world, the
incidence of appendicitis is relatively low in South Africa, but with higher complication and
rupture rates. Although there have been numerous studies published on appendicitis in South
Africa, the literature is notably missing outcome data in the private sector. Therefore, this
study aims to compare acute appendicitis in the public and private sectors in Cape Town,
exploring patient characteristics, perforation rates, outcomes, and return to work.
Methods: A structured literature review was performed on all published studies researching
appendicitis in South Africa. Historical research trends, perforation rates, and other relevant
outcomes were analysed.
A prospective audit was performed for patients undergoing appendicectomy for acute
appendicitis at two public and three private hospitals in Cape Town. Hospital records were
reviewed, including vital data, operative notes, and histology results. Patients were
interviewed during their hospitalisation and four weeks later, exploring their journey of care.
Perforation rates and other relevant outcomes were compared between the public and private
sector cohorts.
Results: Overall, 134 patients were enrolled, with 73 from the public sector and 61 from the
private. Education and employment were higher among private sector patients. Public sector
patients had a higher perforation rate (30.6% vs 13.2%, p=0.023). Times to presentation
were not statistically different between the two groups. Public patients had longer hospital
stays (5.3 vs 2.9 days, p=0.036) and longer return to work times (23.0 vs 12.1 days,p<0.0001). Although complication rates were similar, complications in public hospitals were
more severe.
Discussion: Public sector patients with appendicitis had higher rupture rates, worse
complications, and longer hospital stays than private sector patients. This disparity likely
stems from a combination of social and economic differences that characterise the patient
populations that are served in each sector. Private sector patients have rupture rates similar to
developed nations. Further research is needed to identify and address factors that influence
health-seeking behaviours among public sector patients, to strengthen the health system and
improve appendicitis outcomes.