title: Management of acute appendicitis in a rural population.
abstract: BACKGROUND
  Our system uses a hub and spoke approach to provide surgical care for our rural population. Patients access care anywhere in the system but are transferred centrally for surgical care. We sought to determine if surgical outcome differed depending on where initial care occurred. We chose acute appendicitis (AA) to investigate our care model.
  
  
  METHODS
  We identified patients admitted with the diagnosis of AA. Patients were divided into 2 groups, Bassett Medical Center presentation and satellite center (SAT) presentation. Demographics were compared and, time from system access to surgery, time of surgery, and clinical information associated with care.
  
  
  RESULTS
  There were no differences regarding any clinically relevant factor. SAT patients had longer mean surgery times, 60.7 minutes vs 51.5 (P=.008). Time to surgery, LOS, and complications were similar.
  
  
  CONCLUSIONS
  It is safe to care for AA patients with a hub and spoke approach without putting SAT patients at a disadvantage.
authors: Department of Surgery, West Virginia University, One Medical Center Drive, Morgantown, West Virginia 26506, USA. Electronic address: dcborgstrom@hsc.wvu.edu.
authors: David C
authors: DC
authors: Borgstrom
authors: Bassett Medical Center, Department of Surgery, One Atwell Road, Cooperstown, New York 13326, USA.
authors: Marcos
authors: M
authors: Lopez
authors: Bassett Medical Center, Department of Surgery, One Atwell Road, Cooperstown, New York 13326, USA.
authors: Daniel
authors: D
authors: Hoesterey
authors: Bassett Medical Center, Department of Surgery, One Atwell Road, Cooperstown, New York 13326, USA.
authors: Jennifer
authors: J
authors: Victory
authors: Bassett Medical Center, Department of Surgery, One Atwell Road, Cooperstown, New York 13326, USA.
authors: Olivier
authors: O
authors: Urayeneza
mesh_terms: D000208:Acute Disease; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000453:epidemiology / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D012424:Rural Population
keywords: Acute appendicitis; Hub and spoke approach; Rural health care system; Rural surgery