Laparoscopic appendicectomy: an operation for all trainees but does the learning curve continue into consultanthood?

Area of Science:

• Surgical Outcomes Research
• Comparative Healthcare Analysis
• Gastrointestinal Surgery

Background:

• Appendicitis management differs between public and private hospitals, with registrars in public settings and consultants in private.
• This disparity necessitates a comparative analysis of patient outcomes.

Purpose of the Study:

• To compare demographics, work-up, management, and complication rates for appendicitis patients in public vs. private hospitals.
• To evaluate the impact of surgeon seniority (registrar vs. consultant) on laparoscopic appendicectomy outcomes.

Main Methods:

• Retrospective review of laparoscopic appendicectomies over 13 months at one public and one private hospital.
• Data collected included demographics, admission details, work-up, length of stay, time to surgery, histology, and complications.
• Statistical analysis using Fisher's exact test and unpaired t-test.

Main Results:

• Consultants performed surgery faster (mean 49.79 min) than registrars (mean 67.98 min).
• Private hospitals showed shorter median waiting times (9.5h vs 13h) and lower rates of gangrenous/perforated appendicitis (11.6% vs 26.2%).
• Overall complication rates were similar (8.6% private vs 7.3% public).

Conclusions:

• Consultant-led care is associated with more efficient surgical timing and reduced rates of complicated appendicitis.
• While consultant involvement impacts operative speed and severity of appendicitis, it does not significantly alter overall complication rates.
• Findings suggest benefits of consultant-led services for appendicitis treatment.