For Release: October 26, 2009, 5 p.m.
Contact: David Corriveau, Media Relations Officer, Dartmouth Medical School, 603-653-0771
DMS Cites Rural Risk for Perforated Appendix
Dr. Ian Paquette
Dr. Samuel R.G. Finlayson
Lebanon, N.H.—People who live in rural areas may run a greater risk of suffering a perforated appendix than those dwelling in suburbs and cities, according to a new study from Dartmouth Medical School (DMS) researchers.
During a presentation at the 95th Clinical Congress of the American College of Surgeons (ACS), co-author Ian Paquette, M.D., and his team cited a shortage of general surgeons in the countryside as a possible explanation for the regional disparities.
"This study indirectly looks at workforce issues in surgery," says Paquette, a chief resident in general surgery who collaborated with DMS' Samuel R. G. Finlayson, MD, MPH. "We need to create incentives for surgeons to practice in rural areas."
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that about 325,000 people in the United States are hospitalized each year for appendicitis, and that one in 15 people will develop the condition in their lifetime. Most common in patients ages 10 to 30, the malady inflames the appendix, a small organ projecting from the large intestine near its connection with the small intestine. It triggers sudden and extreme abdominal pain and sends most sufferers to the hospital for emergency surgery before the appendix ruptures or perforates. A perforated appendix can spill contaminated contents of the digestive tract into the body cavity, raising the risk for internal infection and organ damage.
Working at Dartmouth-Hitchcock Medical Center (DHMC), the team determined that 32 percent of patients who went to the hospital with appendicitis showed perforation. However, about 36 percent of rural patients entered the hospital with perforated appendix, compared with 31 percent of urban patients. Even rural patients transferred to urban hospitals showed slightly higher, though not statistically significant, rates of perforation.
Citing a recent report by the ACS Health Policy Research Institute, Paquette observed: "[T]here were 4.6 surgeons per 100,000 people [in rural areas studied], whereas that number in an urban community is 6.5 per 100,000. That number doesn't sound very big, but when you take into account a lower population density spread over a larger geographic area, the magnitude of the disparity in rural areas increases."
Finlayson, an assistant professor of surgery and of community and family medicine, has collaborated with Paquette on several other studies of regional disparities in health care, including a 2007 paper showing rural residents being diagnosed with cancer earlier than those in cities.
Source: American College of Surgeons (ACS)
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