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Exploring geographic variation in acute appendectomy in Ireland: results from a national registry study
  1. Ola Ahmed1,
  2. Ken Mealy2,
  3. Jan Sorensen3
  1. 1 General Surgery, Wexford General Hospital, Wexford, Ireland
  2. 2 General and Colorectal Surgery, Wexford General Hospital, Wexford, Ireland
  3. 3 Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Dr Ola Ahmed; olasdahmed{at}


Objective To explore geographic variations in Irish laparoscopic and open appendectomy procedures.

Design Analysis based on 2014–2017 administrative hospital data from public hospitals.

Setting Counties of Ireland.

Participants Irish residents with hospital admissions for an appendectomy as the principal procedure.

Main outcome measures Age and gender standardised laparoscopic and open appendectomy rates for 26 counties. Geographic variation measured with the extremal quotient (EQ), coefficient of variation (CV) and the systematic component of variation (SCV).

Results 23 684 appendectomies were included. 77.6% (n= 18,387) were performed laparoscopically. An EQ of 8.3 for laparoscopy and 10.0 for open appendectomy was determined. A high CV was demonstrated with a value of 36.7 and 80.8 for laparoscopic and open appendectomy, respectively. An SCV of 14.2 and 124.8 for laparoscopic and open appendectomy was observed. A wider variation was determined when children and adults were assessed separately.

Conclusions The geographic distribution in rates of appendectomy varies considerably across Irish counties. Our data suggest that a patient’s likelihood of undergoing a laparoscopic or open appendectomy is associated with their county of residence.

  • health policy
  • organisation of health services
  • public health
  • paediatric surgery
  • adult surgery
  • appendicitis

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  • Contributors OA conceived and designed the study, analysed the data and drafted and revised the paper. JS designed the study, prepared and analysed the data, drafted and revised the paper. KM interpreted the results and revised the paper. All authors had full access to all the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. OA is the guarantor and affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics board approval was not required for the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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