The case for clinical audit of emergency readmissions after appendicectomy.

The aim of this study was to examine how the Scottish Office Clinical Outcome Indicator for emergency readmissions within 28 days of appendicectomy could be made more useful. Scottish Morbidity Record One (SMRI) data on all NHS discharges with a primary operative procedure of appendicectomy, and a linked file of all emergency readmissions within 28 days of discharge in 1993/94 were used in this study. It was found that 8783 appendicectomies were performed in 1993 and 1994, with 403 (4.6%) emergency readmissions within 28 days. A significantly higher proportion of emergency readmissions occurred where a 'normal' appendix was removed, and in interval, prophylactic and incidental appendicectomies. Age and length of initial hospital stay did not affect readmission rates. Hospitals performing more appendicectomies tended to have more readmissions [Spearman's rank correlation coefficient 0.639 (95% CI 0.430-0.782]. None of the five hospitals carrying out less than 17 appendicectomies in 2 years had an emergency readmission. Patients from more deprived areas were significantly more likely to be readmitted. The current performance indicator is useful in identifying patients readmitted to any hospital in Scotland, but needs to be supplemental with more clinical information. The numbers of appendicectomy patients would make this a feasible national clinical audit project, and the lessons learnt should be useful in promoting better practice for considerable numbers of patients of all ages.