Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide

Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide Beau Scaddan, Balsam Al Asedy, Samantha Lee, Parsa Rastegar Lari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4296850/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Jun, 2024 Read the published version in International Journal of Colorectal Disease → Version 1 posted 4 You are reading this latest preprint version Abstract Purpose: Surgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient’s treatment. The proposed study will be a quantitative multicentre retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia and the effect of this on operative outcomes. Selected outcome measures will be examined by time from initial presentation at an Emergency Department to the patient being diagnosed and then time of diagnosis to surgery being performed. The secondary aim is to compare rates of negative appendicectomies between hospitals. Methods: Appendicectomy patients will be identified from Operating Room register by medical student data collectors, then each respective hospital’s Emergency Room data collection will subsequently be accessed to complete case report forms based on demographics and Clinical Findings, Pre-operative investigations and Management and follow up. Case report forms with >95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This includes the four two-week data collection periods and the subsequent one month follow up per collection period for possible postoperative complications. This study RGS6483 has received HREC approval by the Royal Perth Hospital HREC Ethics Committee, with a waiver of consent obtained. Dissemination of results: Data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. No patient-identifiable data will be entered into the system. Results will subsequently be shared via scientific journal publication and presentation at relevant meetings. appendicectomy appendectomy general surgery acute abdomen appendicitis Introduction Surgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient’s treatment. Clinical evaluation in conjunction with the Alvarado or Appendicitis Inflammatory Response scores are used to determine the risk of appendicitis in symptomatic patients. A large cohort study has shown that, in cases of uncomplicated appendicitis, short delays to operation of < 24 hours do not increase the rates of complex appendicitis [ 1 ]. This finding was confirmed in a meta-analysis of 11 non-randomized studies, where a short in-hospital delay of 12 to 24 hours before surgery did not increase the risk of complex appendicitis including perforation. However, delaying appendicectomy for > 48 hours was associated with increased surgical site infections and other complications [ 2 ]. A Laparoscopic appendicectomy approach should be performed unless contraindicated [ 3 ]. Negative appendicectomy refers to surgical removal of the normal appendix on final pathological report [ 4 ]. The Second Australian Atlas of Healthcare Variation in 2017 revealed that negative appendicectomy rates in Australia were 21–24% [5 ]. With appendicectomies carrying many risks such as possible wound infection or rupture, intestinal injury, postoperative abdominal abscess or urinary infections, unnecessary appendicectomy can have significant impacts [ 6 ]. A recent audit conducted to examine pediatric negative appendicectomy rates at Southwest Health Campus Bunbury including four hundred and twenty one patients found the negative appendicectomy rate to be higher than observed in previous literature at 45.58%. The authors noted this was concerning since diagnostic laparoscopy in children is not benign, with negative appendicectomy having a similar morbidity risk to appendicectomy for uncomplicated appendicitis [ 7 ]. The proposed study will be a quantitative multicentre retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia. The secondary aim is to compare the rates of negative appendicectomies between these hospitals. It is hypothesised that there will be a higher rate of negative appendicectomies in rural hospitals as opposed to metropolitan hospitals, rooting from various potential factors. According to an audit examining the rural-urban differences in surgical interventions in the United States (US), there were higher rates of an array of surgeries including appendicectomies in areas classified rural according to US standards. This was contrary to the authors’ hypothesis that rurally located patients would have lower surgical rates. The authors proposed this could be explained by rural patients experiencing overall poorer health, increasing the indications for many surgeries to be undertaken [ 8 ]. This can be extrapolated to the Australian setting, where, according to the Australian Institute of Health and Welfare (AIHW), risk factors such as smoking, obesity and hypertension amongst many others all increased with rurality, as well as chronic health conditions and burden of disease [ 9 ]. Another factor which may contribute to potential higher negative appendicectomies is that doctors may have a lower threshold to perform the surgery in order to avoid potential severe complications, such as perforation in a setting where there is reduced healthcare access. This may in turn lead to reduced surgical wait times in rural settings, addressing both our primary and secondary outcomes. Another US study on paediatric patients revealed that rural hospitals were 50% more likely to perform negative appendicectomies. The authors explained this is due to negative appendicectomies being justified in order to “decrease delay in diagnosis and subsequently lower the risk of appendiceal perforation” [ 10 ]. The authors noted that this disparity may also be in part due to reduced access to pre-operative imaging such as computed tomography to make the diagnosis. It is suspected a combination of all stated factors may play a role in reduced surgical wait times and negative appendicectomies in rural compared to metropolitan hospitals in Western Australia. The retrospective time period which will be examined for eligible patients and from which data is collected will be over a two year period from January 2022 to November 2023. The planned first data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between January and June 2022 retrospectively to their surgeries being performed, and then a file check of the patient’s 30 day postoperative interval will be conducted to record any readmissions or complications (see more details in Methods section). The planned second data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between June 2022 and December 2022 retrospectively to their surgeries being performed, and then a file check of the patient’s 30 day postoperative interval will be conducted to record any readmissions or complications The planned third data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between January 2023 and June 2023 retrospectively to their surgeries being performed, and then a file check of the patient’s 30 day postoperative interval will be conducted to record any readmissions or complications The planned fourth data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between June 2023 and November 2023 retrospectively to their surgeries being performed, and then a file check of the patient’s 30 day postoperative interval will be conducted to record any readmissions or complications For the purpose of this project, sites under WA Country Health Service jurisdiction will be considered rural, that is Albany Hospital, Bunbury Hospital, Broome Health Campus, Geraldton Hospital, and Hedland Health Campus. The other sites (Royal Perth Hospital, Sir Charles Gairdner Hospital, Fiona Stanley Hospital, Armadale Health Service) will be considered urban. Aim To determine the variation in appendicectomy surgery wait times between rural and urban areas in Western Australia after initial diagnosis at an Emergency Department. Within these populations, selected outcome measures will be examined by time from; 1) Initial presentation at an Emergency Department to the patient being seen by a General Surgery Registrar or Consultant. 2) Pre-emptive diagnosis by a General Surgery Registrar or Consultant to surgery being performed. The reason for taking data based on the two separate time frames is that by recording time between initial Emergency Department presentation (assumed to be the first presentation of the case) to the patient being seen by the General Surgery Registrar or Consultant, it will be possible to account for those patients who are not immediately diagnosed then going on to have a delayed diagnostic laparoscopy and appendicectomy, and evaluate and measure the magnitude of outcome impacts that an increased duration of this time could produce. This will allow examination of the effect of both triage wait times and timing of surgery after diagnosis on perforation, operation duration and length of stay amongst each of the subpopulations. Additionally, it is hoped to establish the rate of negative appendicectomies in urban and rural areas in Western Australia and if necessary make suggestions preoperatively to reduce their incidence. Audit Standards for Outcome Measures : The optimal timing of appendicectomy for uncomplicated acute appendicitis should be within 12 h of initial presentation at an emergency department[ 1 ]. Laparoscopic appendicectomy approach should be performed unless contraindicated [ 3 ]. Primary Outcome Measure Wait time from presentation (hours) to diagnosis and then surgery. This is the number of hours from initial presentation at an emergency department until review by the surgical team, diagnosis and then surgery. These parameters will be recorded on the Case Report Forms as date and time and will be used to compare such wait times between rural and metropolitan hospitals. Secondary Outcome Measures : Rate of laparoscopic appendicectomy This is the number of appendicectomies performed in rural and metropolitan hospitals. This will allow us to explore the overall rate compared to rates of negative appendicectomies in the specified hospitals. Rate of complex appendicitis This is the rate of appendicitis deemed complex based on various parameters. A commonly used scale is the Sunshine Appendicitis Grading System (SAGS) which classifies the severity and complexity of appendicitis but also independently predicts risk of intraabdominal collection. Due to the retrospective nature of this study, it is impossible to determine whether all cases underwent intra-operative classification of severity using the SAGS score. To address this, the case report forms in this study have been adapted to contain a macroscopic (physical) and microscopic (histological) evaluation of the case, which is more likely to have taken place and provides the same information. Hospital stay length – This is the number of days that patients will be remaining in hospital from the date of their initial presentation in the emergency department. This will provide us with further information on the complexity of the cases as well as the post operative health needs of the patients undergoing appendicectomies. Operation duration - This is the duration in hours of the appendicectomies performed in rural and metropolitan hospitals. This again will provide general information about the complexity of cases performed. Rate of negative appendicectomy - This is the rate of appendicectomies performed in normal appendices. This is reported on the Case Report Forms under macroscopic and microscopic appearance, as a normal appendix or simple or complex appendicitis. This will allow us to compare the rates of negative appendicectomies between rural and metropolitan hospitals and provide us with data to examine the potential reasons behind this, outlined in the introduction. Methods Appendicectomy patients will be identified from the Operating Room register by members of the mini-teams discussed in the Methods section, expected to be mainly medical student data collectors currently on placement at the relevant hospital, and then each respective hospital’s Emergency Room data collection subsequently will be accessed to fill out the case report forms. The data will be collated via Case Report Forms based on demographics and Clinical Findings, Pre-operative investigations and Management and follow up. Case report forms with > 95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This includes the 4 two-week data collection periods and the subsequent one month follow up per collection period for possible postoperative complications. Following data collection, only Case Report Forms with > 95% data completeness will be accepted for pooled analysis. Centers with > 5% missing data points will be excluded and collaborators from those centers withdrawn from the published list of citable collaborators. This is in order to provide some leeway for potential missing data, whilst also acknowledging that Case Report Forms with ≥ 5% missing data may not be useful for our purposes. As the data originates from Emergency Department records there is no perceived risk of including false or unused data. Collaborative Teams Steering committee: a group of medical students whose role is to design the protocol, data handling and analysis and final drafting of the paper. Mini-teams: mini-teams consist of 1–3 collaborators at each site whose role is to identify eligible patients receiving appendicectomies during the study periods and collect baseline and follow up data. The mini-teams are planned to consist mainly of student data collectors who are currently on placement at the relevant hospital, recruited through the student research network STRIVE WA. One collaborator is to be selected as the local lead. For every centre there is to be a local lead, ideally a surgical consultant, who coordinates the actions of that centre. Sample size There are over 1600 participants that are planned to be included. This estimate was obtained from the Australian Government Medical Statistics Record, which displayed 818 WA claims for MBS item number 30720, the code for the surgical operation to be examined within this study from July 2022 to June 2023. Assuming this is representative for the beginning of 2022 to the end of 2023, the study window for this project, the number of participants can reasonably be estimated to be double this figure. Amongst the metropolitan hospitals (Royal Perth Hospital, Sir Charles Gairdner Hospital, Fiona Stanley Hospital and Armadale Health Service) there will be 350 participants each and at the rural hospitals (Albany Hospital, Bunbury Hospital, Broome Health Campus, Geraldton Hospital and Hedland Health Campus) there will be 50 participants each. This is reflective of the respective sizes of the hospitals. Data Collection and Storage : Data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. REDCap allows collaborators to enter and store data in a secure system. Collaborators will be given individual REDCap login details, allowing secure data storage on the REDCap system. No identifiable patient information will be collected. Collaborators may wish to first record data on a paper version of the data collection pro-forma. Paper copies of any data should be destroyed as confidential waste within the center once uploaded to REDCap. Identifiable patient information will not be entered into Redcap since only the case report forms will be completed for every eligible instance of appendicectomy surgery. However a review of the patient's file for any complications one month later is necessary and for that the patient's hospital record will be linked to the Redcap entry in the form of assigning each patient a unique study number against which data from all sources will be entered into the study datasheet. During the data collection and checking phases, the CPI will maintain a separate password protected electronic spreadsheet that will link the patient REDCap ID with the patient UMRN, making the study dataset re-identifiable (coded) during these phases. Once the dataset is finalised and the data has been checked for errors or missing data, the file containing the link codes will be deleted, rendering the study dataset non-identifiable. The follow up will be only in the form of a check for any complications or readmissions in the patient's hospital record and will not require any involvement on behalf of the patient. Essentially this study involves nothing from the participants themselves at all, only a retrospective review of their surgery admission and a check of their patient file one month later. A report of the study will be sent to a medical journal approximately four months following completion of data analysis and due to patient anonymity they will not be informed of the outcomes of the project. Criteria Inclusion Criteria: All patients who undergo an appendicectomy during the study period. Age 16 years or older at time of presentation Exclusion Criteria: Previous appendicectomy or right hemi-colectomy or total colectomy. Current Pregnancy at time of presentation Data analysis Normally distributed data will be reported as mean (standard deviation (SD)) and non normally distributed data will be reported as median (interquartile range (IQR)). Independent t-tests or ANOVAs will be used for normally distributed variables, Mann Whitney U & Kruskal-Wallis tests will be used for non-normally distributed continuous or ordinal variables and Chi squared tests will be used for categorical variable comparisons. When comparing appendicectomy wait times with complication incidence during the data analysis phase, a P value of .05 will be used to determine statistical significance. There will be no interim analysis planned due to the grouping of data sets over 4 data collection periods. As this is a retrospective observational cohort study, there are no plans to deviate from the original statistical plan or study design. Declarations Competing interests No competing interests are declared for this project by the authors. Author Contribution Statement Beau Scaddan was responsible for the study design and methods including data storage; Balsam Al Asedy contributed to the Introduction and Outcome Measure definitions; Parsa Rastegar Lari wrote the Center Survey Forms (Supplementary Tables 1–3) and part of the Introduction; Samantha Lee completed the Case Report forms. All authors reviewed the manuscript. Funding statement This is a medical-student led collaborative research project that does not receive any external funding. Author Contribution B. S. was responsible for the study design and methods including data storage; B. A. A contributed to the Introduction and Outcome Measure definitions; P. R.L. wrote the Center Survey Forms (Supplementary Tables 1-3) and part of the Introduction; S. L. completed the Case Report forms. All authors reviewed the manuscript. Acknowledgement The authors would like to acknowledge Dr Talia Shepherd and Professor Daniel Fatovich who provided feedback on manuscript drafts of the study design. TIMELINE AND DURATION (SUBJECT TO CHANGE): March 2023 Protocol launch March - May 2024 Recruitment of participating centers and local teams Local audit registration May 2024 Local audit registration deadline June 2024 Issue of data collector (Redcap) 1st Data collection period June 13th – 26th 2024 Examining Jan to June 2022 2nd Data collection period July 24th – August 7th 2024 Examining June to December 2022 3rd Data collection period August 5th – 18th 2024 Examining Jan 2023 to June 2023 4th Data collection period September 19th – 2nd October 2024 Examining June 2023 to December 2023 September 2024 Data validation protocol released November 2024 Data validation deadline October 31st 2024 REDCap database locked, final data submission deadline November 2024 Data analysis and write up Conference abstract submissions Manuscript submission References United Kingdom National Surgical Research Collaborative, Bhangu A (2014) Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg 259(5):894–903 Eko FN, Ryb GE, Drager L, Goldwater E, Wu JJ, Counihan TC (2013) Ideal timing of surgery for acute uncomplicated appendicitis. N Am J Med Sci 5(1):22–27 Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M et al (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 11:34 Chaochankit W, Boocha A, Samphao S (2022) Negative appendicectomy rate in patients diagnosed with acute appendicitis. BMC Surg 22(1):404–404 Australian Commission on Safety and Quality in Health Care. Second Australian Atlas of Healthcare Variation. Sydney (NSW): Commonwealth of Australia (2017) : 294 Andersson RE (2014) Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a national cohort. Br J Surg 101(9):1135–1142 Behrendorff N, Palan R, McKitterick T, Cover J (2023) Paediatric negative appendicectomy rates at a regional Western Australian Centre: a five-year cohort study. ANZ J Surg 93:1987–1992 Francis ML, Scaife SL, Zahnd WE (2011) Rural-Urban Differences in Surgical Procedures for Medicare Beneficiaries. Arch Surg 146(5):579–583. 10.1001/archsurg.2010.306 Australian Institute of Health and Welfare. Rural and remote health [Internet]. Canberra: Australian Institute of Health and Welfare (2023) https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health (accessed Feb 2024) Tom C et al (2019) Outcomes and costs of pediatric appendicectomies at rural hospitals. J Pediatr Surg 54(1):103–107 Additional Declarations No competing interests reported. Supplementary Files CASEREPORTFORMSIJCS.docx Cite Share Download PDF Status: Published Journal Publication published 13 Jun, 2024 Read the published version in International Journal of Colorectal Disease → Version 1 posted Editorial decision: Revision requested 25 Apr, 2024 Editor assigned by journal 22 Apr, 2024 Submission checks completed at journal 22 Apr, 2024 First submitted to journal 20 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4296850","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":295360285,"identity":"9b49f567-d26f-4dc4-af89-c32824455426","order_by":0,"name":"Beau Scaddan","email":"data:image/png;base64,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","orcid":"","institution":"Curtin University","correspondingAuthor":true,"prefix":"","firstName":"Beau","middleName":"","lastName":"Scaddan","suffix":""},{"id":295360286,"identity":"b237fafb-b25d-4dac-94a7-f653a040b99b","order_by":1,"name":"Balsam Al Asedy","email":"","orcid":"","institution":"Curtin University","correspondingAuthor":false,"prefix":"","firstName":"Balsam","middleName":"Al","lastName":"Asedy","suffix":""},{"id":295360287,"identity":"1cf5c3a0-103f-4dac-ae47-7c91aa942676","order_by":2,"name":"Samantha Lee","email":"","orcid":"","institution":"University of Western Australia","correspondingAuthor":false,"prefix":"","firstName":"Samantha","middleName":"","lastName":"Lee","suffix":""},{"id":295360288,"identity":"5182eb53-1dff-4772-916a-de05248892d3","order_by":3,"name":"Parsa Rastegar Lari","email":"","orcid":"","institution":"University of Western Australia","correspondingAuthor":false,"prefix":"","firstName":"Parsa","middleName":"Rastegar","lastName":"Lari","suffix":""}],"badges":[],"createdAt":"2024-04-20 09:39:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4296850/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4296850/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00384-024-04662-3","type":"published","date":"2024-06-13T14:52:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58822252,"identity":"51a380b2-3e08-44d4-9a4e-0d3447c9fa12","added_by":"auto","created_at":"2024-06-21 16:39:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":366730,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4296850/v1/06d8e76c-5663-4b3e-af48-eb65a5a8c9ed.pdf"},{"id":55367031,"identity":"f349708d-5c7f-4057-965c-2ba2efffa024","added_by":"auto","created_at":"2024-04-26 10:05:58","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":33363,"visible":true,"origin":"","legend":"","description":"","filename":"CASEREPORTFORMSIJCS.docx","url":"https://assets-eu.researchsquare.com/files/rs-4296850/v1/4fe549bbf129c7a2674adcdc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSurgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient\u0026rsquo;s treatment. Clinical evaluation in conjunction with the Alvarado or Appendicitis Inflammatory Response scores are used to determine the risk of appendicitis in symptomatic patients. A large cohort study has shown that, in cases of uncomplicated appendicitis, short delays to operation of \u0026lt;\u0026thinsp;24 hours do not increase the rates of complex appendicitis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This finding was confirmed in a meta-analysis of 11 non-randomized studies, where a short in-hospital delay of 12 to 24 hours before surgery did not increase the risk of complex appendicitis including perforation. However, delaying appendicectomy for \u0026gt;\u0026thinsp;48 hours was associated with increased surgical site infections and other complications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A Laparoscopic appendicectomy approach should be performed unless contraindicated [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNegative appendicectomy refers to surgical removal of the normal appendix on final pathological report [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The Second Australian Atlas of Healthcare Variation in 2017 revealed that negative appendicectomy rates in Australia were 21\u0026ndash;24% [5 ]. With appendicectomies carrying many risks such as possible wound infection or rupture, intestinal injury, postoperative abdominal abscess or urinary infections, unnecessary appendicectomy can have significant impacts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A recent audit conducted to examine pediatric negative appendicectomy rates at Southwest Health Campus Bunbury including four hundred and twenty one patients found the negative appendicectomy rate to be higher than observed in previous literature at 45.58%. The authors noted this was concerning since diagnostic laparoscopy in children is not benign, with negative appendicectomy having a similar morbidity risk to appendicectomy for uncomplicated appendicitis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe proposed study will be a quantitative multicentre retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia. The secondary aim is to compare the rates of negative appendicectomies between these hospitals.\u003c/p\u003e \u003cp\u003eIt is hypothesised that there will be a higher rate of negative appendicectomies in rural hospitals as opposed to metropolitan hospitals, rooting from various potential factors. According to an audit examining the rural-urban differences in surgical interventions in the United States (US), there were higher rates of an array of surgeries including appendicectomies in areas classified rural according to US standards. This was contrary to the authors\u0026rsquo; hypothesis that rurally located patients would have lower surgical rates. The authors proposed this could be explained by rural patients experiencing overall poorer health, increasing the indications for many surgeries to be undertaken [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This can be extrapolated to the Australian setting, where, according to the Australian Institute of Health and Welfare (AIHW), risk factors such as smoking, obesity and hypertension amongst many others all increased with rurality, as well as chronic health conditions and burden of disease [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Another factor which may contribute to potential higher negative appendicectomies is that doctors may have a lower threshold to perform the surgery in order to avoid potential severe complications, such as perforation in a setting where there is reduced healthcare access. This may in turn lead to reduced surgical wait times in rural settings, addressing both our primary and secondary outcomes. Another US study on paediatric patients revealed that rural hospitals were 50% more likely to perform negative appendicectomies. The authors explained this is due to negative appendicectomies being justified in order to \u0026ldquo;decrease delay in diagnosis and subsequently lower the risk of appendiceal perforation\u0026rdquo; [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The authors noted that this disparity may also be in part due to reduced access to pre-operative imaging such as computed tomography to make the diagnosis. It is suspected a combination of all stated factors may play a role in reduced surgical wait times and negative appendicectomies in rural compared to metropolitan hospitals in Western Australia.\u003c/p\u003e \u003cp\u003eThe retrospective time period which will be examined for eligible patients and from which data is collected will be over a two year period from January 2022 to November 2023.\u003c/p\u003e \u003cp\u003eThe planned first data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between January and June 2022 retrospectively to their surgeries being performed, and then a file check of the patient\u0026rsquo;s 30 day postoperative interval will be conducted to record any readmissions or complications (see more details in Methods section).\u003c/p\u003e \u003cp\u003eThe planned second data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between June 2022 and December 2022 retrospectively to their surgeries being performed, and then a file check of the patient\u0026rsquo;s 30 day postoperative interval will be conducted to record any readmissions or complications\u003c/p\u003e \u003cp\u003eThe planned third data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between January 2023 and June 2023 retrospectively to their surgeries being performed, and then a file check of the patient\u0026rsquo;s 30 day postoperative interval will be conducted to record any readmissions or complications\u003c/p\u003e \u003cp\u003eThe planned fourth data collection period will only record information for eligible patients receiving appendicectomy at the relevant center between June 2023 and November 2023 retrospectively to their surgeries being performed, and then a file check of the patient\u0026rsquo;s 30 day postoperative interval will be conducted to record any readmissions or complications\u003c/p\u003e \u003cp\u003eFor the purpose of this project, sites under WA Country Health Service jurisdiction will be considered rural, that is Albany Hospital, Bunbury Hospital, Broome Health Campus, Geraldton Hospital, and Hedland Health Campus. The other sites (Royal Perth Hospital, Sir Charles Gairdner Hospital, Fiona Stanley Hospital, Armadale Health Service) will be considered urban.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAim\u003c/strong\u003e \u003cp\u003eTo determine the variation in appendicectomy surgery wait times between rural and urban areas in Western Australia after initial diagnosis at an Emergency Department. Within these populations, selected outcome measures will be examined by time from;\u003c/p\u003e \u003c/p\u003e \u003cp\u003e1) Initial presentation at an Emergency Department to the patient being seen by a General Surgery Registrar or Consultant.\u003c/p\u003e \u003cp\u003e2) Pre-emptive diagnosis by a General Surgery Registrar or Consultant to surgery being performed.\u003c/p\u003e \u003cp\u003eThe reason for taking data based on the two separate time frames is that by recording time between initial Emergency Department presentation (assumed to be the first presentation of the case) to the patient being seen by the General Surgery Registrar or Consultant, it will be possible to account for those patients who are not immediately diagnosed then going on to have a delayed diagnostic laparoscopy and appendicectomy, and evaluate and measure the magnitude of outcome impacts that an increased duration of this time could produce.\u003c/p\u003e \u003cp\u003eThis will allow examination of the effect of both triage wait times and timing of surgery after diagnosis on perforation, operation duration and length of stay amongst each of the subpopulations.\u003c/p\u003e \u003cp\u003eAdditionally, it is hoped to establish the rate of negative appendicectomies in urban and rural areas in Western Australia and if necessary make suggestions preoperatively to reduce their incidence.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAudit Standards for Outcome Measures\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe optimal timing of appendicectomy for uncomplicated acute appendicitis should be within 12 h of initial presentation at an emergency department[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLaparoscopic appendicectomy approach should be performed unless contraindicated [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePrimary Outcome Measure\u003c/strong\u003e \u003cp\u003eWait time from presentation (hours) to diagnosis and then surgery. This is the number of hours from initial presentation at an emergency department until review by the surgical team, diagnosis and then surgery. These parameters will be recorded on the Case Report Forms as date and time and will be used to compare such wait times between rural and metropolitan hospitals.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSecondary Outcome Measures\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRate of laparoscopic appendicectomy\u003c/strong\u003e \u003cp\u003eThis is the number of appendicectomies performed in rural and metropolitan hospitals. This will allow us to explore the overall rate compared to rates of negative appendicectomies in the specified hospitals.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRate of complex appendicitis\u003c/strong\u003e \u003cp\u003eThis is the rate of appendicitis deemed complex based on various parameters. A commonly used scale is the Sunshine Appendicitis Grading System (SAGS) which classifies the severity and complexity of appendicitis but also independently predicts risk of intraabdominal collection. Due to the retrospective nature of this study, it is impossible to determine whether all cases underwent intra-operative classification of severity using the SAGS score. To address this, the case report forms in this study have been adapted to contain a macroscopic (physical) and microscopic (histological) evaluation of the case, which is more likely to have taken place and provides the same information.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHospital stay length \u0026ndash;\u003c/b\u003e This is the number of days that patients will be remaining in hospital from the date of their initial presentation in the emergency department. This will provide us with further information on the complexity of the cases as well as the post operative health needs of the patients undergoing appendicectomies.\u003c/p\u003e \u003cp\u003e \u003cb\u003eOperation duration\u003c/b\u003e - This is the duration in hours of the appendicectomies performed in rural and metropolitan hospitals. This again will provide general information about the complexity of cases performed.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRate of negative appendicectomy -\u003c/b\u003e This is the rate of appendicectomies performed in normal appendices. This is reported on the Case Report Forms under macroscopic and microscopic appearance, as a normal appendix or simple or complex appendicitis. This will allow us to compare the rates of negative appendicectomies between rural and metropolitan hospitals and provide us with data to examine the potential reasons behind this, outlined in the introduction.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eAppendicectomy patients will be identified from the Operating Room register by members of the mini-teams discussed in the Methods section, expected to be mainly medical student data collectors currently on placement at the relevant hospital, and then each respective hospital\u0026rsquo;s Emergency Room data collection subsequently will be accessed to fill out the case report forms. The data will be collated via Case Report Forms based on demographics and Clinical Findings, Pre-operative investigations and Management and follow up. Case report forms with \u0026gt;\u0026thinsp;95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This includes the 4 two-week data collection periods and the subsequent one month follow up per collection period for possible postoperative complications.\u003c/p\u003e \u003cp\u003eFollowing data collection, only Case Report Forms with \u0026gt;\u0026thinsp;95% data completeness will be accepted for pooled analysis. Centers with \u0026gt;\u0026thinsp;5% missing data points will be excluded and collaborators from those centers withdrawn from the published list of citable collaborators. This is in order to provide some leeway for potential missing data, whilst also acknowledging that Case Report Forms with \u0026ge;\u0026thinsp;5% missing data may not be useful for our purposes. As the data originates from Emergency Department records there is no perceived risk of including false or unused data.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCollaborative Teams\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSteering committee: a group of medical students whose role is to design the protocol, data handling and analysis and final drafting of the paper.\u003c/p\u003e \u003cp\u003eMini-teams: mini-teams consist of 1\u0026ndash;3 collaborators at each site whose role is to identify eligible patients receiving appendicectomies during the study periods and collect baseline and follow up data. The mini-teams are planned to consist mainly of student data collectors who are currently on placement at the relevant hospital, recruited through the student research network STRIVE WA. One collaborator is to be selected as the local lead. For every centre there is to be a local lead, ideally a surgical consultant, who coordinates the actions of that centre.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSample size\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere are over 1600 participants that are planned to be included. This estimate was obtained from the Australian Government Medical Statistics Record, which displayed 818 WA claims for MBS item number 30720, the code for the surgical operation to be examined within this study from July 2022 to June 2023. Assuming this is representative for the beginning of 2022 to the end of 2023, the study window for this project, the number of participants can reasonably be estimated to be double this figure.\u003c/p\u003e \u003cp\u003eAmongst the metropolitan hospitals (Royal Perth Hospital, Sir Charles Gairdner Hospital, Fiona Stanley Hospital and Armadale Health Service) there will be 350 participants each and at the rural hospitals (Albany Hospital, Bunbury Hospital, Broome Health Campus, Geraldton Hospital and Hedland Health Campus) there will be 50 participants each. This is reflective of the respective sizes of the hospitals.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData Collection and Storage\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eData will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. REDCap allows collaborators to enter and store data in a secure system. Collaborators will be given individual REDCap login details, allowing secure data storage on the REDCap system. No identifiable patient information will be collected. Collaborators may wish to first record data on a paper version of the data collection pro-forma. Paper copies of any data should be destroyed as confidential waste within the center once uploaded to REDCap.\u003c/p\u003e \u003cp\u003eIdentifiable patient information will not be entered into Redcap since only the case report forms will be completed for every eligible instance of appendicectomy surgery. However a review of the patient's file for any complications one month later is necessary and for that the patient's hospital record will be linked to the Redcap entry in the form of assigning each patient a unique study number against which data from all sources will be entered into the study datasheet. During the data collection and checking phases, the CPI will maintain a separate password protected electronic spreadsheet that will link the patient REDCap ID with the patient UMRN, making the study dataset re-identifiable (coded) during these phases. Once the dataset is finalised and the data has been checked for errors or missing data, the file containing the link codes will be deleted, rendering the study dataset non-identifiable.\u003c/p\u003e \u003cp\u003eThe follow up will be only in the form of a check for any complications or readmissions in the patient's hospital record and will not require any involvement on behalf of the patient. Essentially this study involves nothing from the participants themselves at all, only a retrospective review of their surgery admission and a check of their patient file one month later. A report of the study will be sent to a medical journal approximately four months following completion of data analysis and due to patient anonymity they will not be informed of the outcomes of the project.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCriteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003eInclusion Criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAll patients who undergo an appendicectomy during the study period.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAge 16 years or older at time of presentation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eExclusion Criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePrevious appendicectomy or right hemi-colectomy or total colectomy.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCurrent Pregnancy at time of presentation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNormally distributed data will be reported as mean (standard deviation (SD)) and non normally distributed data will be reported as median (interquartile range (IQR)). Independent t-tests or ANOVAs will be used for normally distributed variables, Mann Whitney U \u0026amp; Kruskal-Wallis tests will be used for non-normally distributed continuous or ordinal variables and Chi squared tests will be used for categorical variable comparisons. When comparing appendicectomy wait times with complication incidence during the data analysis phase, a P value of .05 will be used to determine statistical significance. There will be no interim analysis planned due to the grouping of data sets over 4 data collection periods. As this is a retrospective observational cohort study, there are no plans to deviate from the original statistical plan or study design.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eNo competing interests are declared for this project by the authors.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthor Contribution Statement\u003c/h2\u003e \u003cp\u003eBeau Scaddan was responsible for the study design and methods including data storage; Balsam Al Asedy contributed to the Introduction and Outcome Measure definitions; Parsa Rastegar Lari wrote the Center Survey Forms (Supplementary Tables\u0026nbsp;1\u0026ndash;3) and part of the Introduction; Samantha Lee completed the Case Report forms. All authors reviewed the manuscript.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding statement\u003c/h2\u003e \u003cp\u003eThis is a medical-student led collaborative research project that does not receive any external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eB. S. was responsible for the study design and methods including data storage; B. A. A contributed to the Introduction and Outcome Measure definitions; P. R.L. wrote the Center Survey Forms (Supplementary Tables 1-3) and part of the Introduction; S. L. completed the Case Report forms. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to acknowledge Dr Talia Shepherd and Professor Daniel Fatovich who provided feedback on manuscript drafts of the study design.\u003c/p\u003e\n\u003cp\u003eTIMELINE AND DURATION (SUBJECT TO CHANGE):\u003c/p\u003e\u003cp\u003eMarch 2023 Protocol launch\u003c/p\u003e\u003cp\u003eMarch - May 2024 Recruitment of participating centers and local teams Local audit registration\u003c/p\u003e\u003cp\u003eMay 2024 Local audit registration deadline\u003c/p\u003e\u003cp\u003eJune 2024 Issue of data collector (Redcap)\u003c/p\u003e\u003cp\u003e1st Data collection period June 13th \u0026ndash; 26th 2024 Examining Jan to June 2022\u003c/p\u003e\u003cp\u003e2nd Data collection period July 24th \u0026ndash; August 7th 2024 Examining June to December 2022\u003c/p\u003e\u003cp\u003e3rd Data collection period August 5th \u0026ndash; 18th 2024 Examining Jan 2023 to June 2023\u003c/p\u003e\u003cp\u003e4th Data collection period September 19th \u0026ndash; 2nd October 2024 Examining June 2023 to December 2023\u003c/p\u003e\u003cp\u003eSeptember 2024 Data validation protocol released\u003c/p\u003e\u003cp\u003eNovember 2024 Data validation deadline\u003c/p\u003e\u003cp\u003eOctober 31st 2024 REDCap database locked, final data submission deadline\u003c/p\u003e\u003cp\u003eNovember 2024 Data analysis and write up\u003c/p\u003e\u003cp\u003eConference abstract submissions\u003c/p\u003e\u003cp\u003eManuscript submission\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUnited Kingdom National Surgical Research Collaborative, Bhangu A (2014) Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg 259(5):894\u0026ndash;903\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEko FN, Ryb GE, Drager L, Goldwater E, Wu JJ, Counihan TC (2013) Ideal timing of surgery for acute uncomplicated appendicitis. N Am J Med Sci 5(1):22\u0026ndash;27\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M et al (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 11:34\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaochankit W, Boocha A, Samphao S (2022) Negative appendicectomy rate in patients diagnosed with acute appendicitis. BMC Surg 22(1):404\u0026ndash;404\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Commission on Safety and Quality in Health Care. Second Australian Atlas of Healthcare Variation. Sydney (NSW): Commonwealth of Australia (2017) : 294\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndersson RE (2014) Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a national cohort. Br J Surg 101(9):1135\u0026ndash;1142\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehrendorff N, Palan R, McKitterick T, Cover J (2023) Paediatric negative appendicectomy rates at a regional Western Australian Centre: a five-year cohort study. ANZ J Surg 93:1987\u0026ndash;1992\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrancis ML, Scaife SL, Zahnd WE (2011) Rural-Urban Differences in Surgical Procedures for Medicare Beneficiaries. Arch Surg 146(5):579\u0026ndash;583. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archsurg.2010.306\u003c/span\u003e\u003cspan address=\"10.1001/archsurg.2010.306\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare. Rural and remote health [Internet]. Canberra: Australian Institute of Health and Welfare (2023) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health\u003c/span\u003e\u003cspan address=\"https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed Feb 2024)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTom C et al (2019) Outcomes and costs of pediatric appendicectomies at rural hospitals. J Pediatr Surg 54(1):103\u0026ndash;107\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-colorectal-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcd","sideBox":"Learn more about [International Journal of Colorectal Disease](http://link.springer.com/journal/384)","snPcode":"384","submissionUrl":"https://submission.nature.com/new-submission/384/3","title":"International Journal of Colorectal Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"appendicectomy, appendectomy, general surgery, acute abdomen, appendicitis","lastPublishedDoi":"10.21203/rs.3.rs-4296850/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4296850/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Surgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient’s treatment. The proposed study will be a quantitative multicentre retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia and the effect of this on operative outcomes. Selected outcome measures will be examined by time from initial presentation at an Emergency Department to the patient being diagnosed and then time of diagnosis to surgery being performed. The secondary aim is to compare rates of negative appendicectomies between hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Appendicectomy patients will be identified from Operating Room register by medical student data collectors, then each respective hospital’s Emergency Room data collection will subsequently be accessed to complete case report forms based on demographics and Clinical Findings, Pre-operative investigations and Management and follow up. Case report forms with \u0026gt;95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This includes the four two-week data collection periods and the subsequent one month follow up per collection period for possible postoperative complications. This study RGS6483 has received HREC approval by the Royal Perth Hospital HREC Ethics Committee, with a waiver of consent obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDissemination of results:\u003c/strong\u003e Data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. No patient-identifiable data will be entered into the system. Results will subsequently be shared via scientific journal publication and presentation at relevant meetings.\u003c/p\u003e","manuscriptTitle":"Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-26 10:05:53","doi":"10.21203/rs.3.rs-4296850/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-25T10:10:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-23T00:36:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-23T00:36:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Colorectal Disease","date":"2024-04-20T09:30:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-colorectal-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcd","sideBox":"Learn more about [International Journal of Colorectal Disease](http://link.springer.com/journal/384)","snPcode":"384","submissionUrl":"https://submission.nature.com/new-submission/384/3","title":"International Journal of Colorectal Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a915267e-b595-4e92-834a-426128558d7e","owner":[],"postedDate":"April 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-06-21T14:52:56+00:00","versionOfRecord":{"articleIdentity":"rs-4296850","link":"https://doi.org/10.1007/s00384-024-04662-3","journal":{"identity":"international-journal-of-colorectal-disease","isVorOnly":false,"title":"International Journal of Colorectal Disease"},"publishedOn":"2024-06-13 14:52:56","publishedOnDateReadable":"June 13th, 2024"},"versionCreatedAt":"2024-04-26 10:05:53","video":"","vorDoi":"10.1007/s00384-024-04662-3","vorDoiUrl":"https://doi.org/10.1007/s00384-024-04662-3","workflowStages":[]},"version":"v1","identity":"rs-4296850","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4296850","identity":"rs-4296850","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}