Appendicectomy in Scotland: a 20-year epidemiological comparison.

BACKGROUND The objective of the research was to study the pattern of appendicectomies in Scotland over the last 20 years. METHOD Routine National Health Service data on patients discharged after appendicectomy in Scotland during 1973-1993 were analysed. RESULTS For all ages, the appendicectomy rate has fallen steadily from 1.97 per 1000 (10,325 operations) in 1973 to 0.96 per 1000 (4906 operations) in 1993. The proportion of emergency operations increased from 76 to 80 per cent. The median age at operation rose from 18 to 22 years. The proportion of male patients remained higher for emergency operations, whereas the proportion of females, and age at operation, were both higher for non-emergency appendicectomies. In the period 1992-1995, appendicectomy rates were higher for patients with postcodes in areas of greater deprivation, particularly for children aged 0-14 years. Variation in childhood appendicectomy rates across Scotland has declined: apart from Ayrshire and Arran, which had a lower than expected rate, no Health Board had a rate significantly different from the rate in the rest of Scotland in 1993. The case fatality rate fell from 7.0 per 1000 to 1.6 per 1000 (with all the latter deaths in elderly patients). CONCLUSION Over the last 20 years, appendicectomy rates have declined in Scotland and there is now greater uniformity of childhood appendicectomy rates across Scotland.