title: Appendicitis: what does really make the difference between private and public hospitals?
abstract: BACKGROUND
  Appendicitis is one of the most common surgical emergencies and is also a time-sensitive condition. Delays in treatment increase the risk of appendiceal perforation (AP), and thus AP rates have been used as a proxy to measure access to surgical care. It is very well known that in Brazil there are big differences between the public and private healthcare systems. Those differences can reflect in the treatment of what are considered simple cases, like appendicitis. As far as we know, it has no known links to behavioral or social risk factors, and has only one treatment option--appendectomy. The purpose of this study was to compare treatment received by Brazilian people, both by those who depend on the public and private healthcare system, and how it affects their outcome.
  
  
  METHODS
  Data was collected from the records of all patients submitted to appendectomy, in a public and in a private Sao Paulo city's hospitals, during January to April of 2010.
  
  
  RESULTS
  Patients admitted by the public hospital present symptoms for a longer period of time than those treated by the private one. It took a significantly higher amount of time for the patients from the public hospital undergo surgery, and their length of stay is also significantly higher.
  
  
  CONCLUSIONS
  Appendicitis in a public scenario is associated with increased time from onset of symptoms to operative intervention and the main reason is the delayed presentation. Clinical polices for abdominal pain should be instituted by the public healthcare system, based on population education, healthcare professionals training and establishment of strategies that can speed the diagnosis process up.
authors.affiliation: Emergency Department, Unidade de Primeiro Atendimento, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627 - 1o Andar, 05651-901, São Paulo, Brazil. miltons@einstein.br
authors.forename: Milton
authors.initials: M
authors.lastname: Steinman
authors.forename: Patrícia S
authors.initials: PS
authors.lastname: Rogeri
authors.forename: Lia L
authors.initials: LL
authors.lastname: Lenci
authors.forename: Clara C
authors.initials: CC
authors.lastname: Kirschner
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Teixeira
authors.forename: Paulo David S
authors.initials: PD
authors.lastname: Gonçalves
authors.forename: Nelson
authors.initials: N
authors.lastname: Akamine
authors.forename: Silvio
authors.initials: S
authors.lastname: Possa
mesh_terms: D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000601:surgery*; D001938:Brazil; D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008485:Medical Audit; D011859:Radiography; D012189:Retrospective Studies; D012923:Social Class; D014463:Ultrasonography; D055815:Young Adult
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