Spatial Accessibility to Emergency Departments and Surgical Treatment for Patients with Acute Appendicitis in South Korea.

PURPOSE: Recent concerns regarding the delivery of surgical services in South Korea emphasize the need for close monitoring of spatial access to surgical care in patients with acute appendicitis at the regional level.

MATERIALS AND

METHODS

This study included emergency department (ED) visits with acute appendicitis and subsequent appendectomies from the National Emergency Department Information System database (2015-2021). Travel distances to the hospital were measured, and the proportion of patients admitted to regional hospitals was visualized on a geographic map. Factors related to complicated appendicitis were analyzed using logistic regression.

RESULTS

Among 207344 patients who visited the EDs, those from areas with low population density had higher proportions of patients aged ≥65 years (23.2%), Medical Aid recipients (4.8%), transfers from other hospitals (39.3%), and cases of complicated appendicitis (7.0%) compared to other regions. Additionally, patients in low-density regions had the highest proportion of traveling 50 km or more (27.7%), compared to those in mid-density (5.9%) and high-density (2.5%) regions. In the multivariate analysis, patients aged ≥65 years exhibited a stronger association with complicated appendicitis compared to other age groups.

CONCLUSION

The current results suggested that regions with low population density experienced low access to surgical care, revealing significant regional variation linked to population density. Given the rapidly aging population and the concentration of residents in urban areas in South Korea, urgent policy action is needed to ensure the adequate delivery of emergency general surgery services in low-density regions.