H. Tessman1, J. Hartwell1 1University of Kansas Medical Center, Emergency General Surgery/Trauma Surgery, Kansas City, KANSAS, USA
Introduction: Previous studies have shown scarce data on the follow-up patterns of postoperative appendectomy patients and their impact on complication rates. A higher-than-expected number of appendectomy patients have experienced complications at the University of Kansas Medical Center (KUMC) on the Emergency General Surgery (EGS) service. As charts were reviewed for relevant complications, it was noticed that some patients were not showing up for their in-person follow-up appointments. This study examined the follow-up status of appendectomy patients, modifiable factors impacting follow-up, and their relationship with post-operative complications.
Methods: 158 patients who underwent appendectomy from July 2022 to December 2023 were included for analysis. Patients treated non-operatively with antibiotics were excluded from the study. The follow-up status of patients was analyzed by whether they followed up in-person, had telephone communication with the EGS service, or did not follow-up. Modifiable factors included whether the patient had a social work consult, primary care provider (PCP), gastroenterologist (GI) specialist, and whether they followed-up with another provider if they did not follow-up with the EGS service. Demographic factors were insurance status and zip code as a marker of socioeconomic status. All factors were tested for their association with complications. A poverty rate was calculated and tested for its association with complications.
Results: There was no statistical significance for the relationship between follow-up status and postoperative complications (0.313) or AAST grade of appendicitis (0.704). There was a slightly higher mean poverty rate in patients that had complications (mean poverty index=13) compared to those who did not (mean poverty index=12.7). There was a higher mean poverty rate for those that did not follow-up (15.1) compared to those that did (12.6). There was not a significant relationship between complications and poverty rate (p=0.799). The only factor that had a significant relationship with appendectomy complications was insurance status (p=0.012). The insurance status also had a near significant relationship with follow-up status as well (p=0.059). Other modifiable factors did not have any statistical significance in relation to complications, including PCP status (p=0.399), GI specialist (p=0.772), and other provider status (p=0.955). These modifiable factors also did not show a significant relationship with follow-up status: PCP status (p=0.068), GI specialist (p=0.533), and other provider status (p=0.251).
Conclusion: While many factors influence postoperative appendectomy complications in, follow-up status does not appear to be a contributor The EGS service at KUMC provides adequate follow-up care of appendectomy patients and did not experience any missed complication due to lack of follow-up. The majority of patients that did not follow-up had shorter lengths of stay and lower AAST grade appendicitis and would be expected to follow-up less and experience a lower portion of complications. Referral to financial assistance programs, providing financial resource information, or social work referral should be considered at a post-operative appendectomy visit if the patient does not have any insurance. In addition, there were no social work consults utilized by the EGS department so this could be addressed as well. The post-operative visit could also include referral to a primary care provider, if the patient does not have one. In future studies, a quality improvement initiative could be examined that uses insurance status as a metric to target patients who have financial issues, primary care provider needs, and social work needs to mitigate complications.