Is acute appendicitis more severe in foreign workers of northern Israel? A retrospective cohort study

Chovav Handler, Noam Weiner, Eyal Meir, Ossama Abu-Hatoum, Doron Kopelman, Uri Kaplan

Research output: Contribution to journalArticlepeer-review


Background: Acute appendicitis (AA) is one of the most common surgical emergencies worldwide. It’s classified into simple or complicated disease. Due to the high prevalence of the disease, AA has been studied as a marker to assess the quality of care afforded to minority groups. The purpose of this study was to compare AA outcomes in foreign workers (FW) to the general population in northern Israel. Methods: This is a retrospective cohort study. We identified all patients aged 18–50 who were admitted to our institution between January 1st, 2013 and October 31st, 2018, with the diagnosis of acute appendicitis. The study group included all FW and the control group included citizens of Israel. Study patients were matched based on age, sex, and co-morbidities. We compared time to presentation, admission parameters and disease outcomes. Our study outcomes were disease severity and length of hospital stay. Results: We identified 20 FW and 97 matched local patients. FW presented with significantly higher heart rate, temperature, and white blood cell count (WBC). Duration of symptoms was comparable between the two groups. The rates of complicated disease were significantly higher among FW (45 vs 17.5%, p < 0.0001). Length of hospitalization was significantly longer in the FW group (4.8 vs. 3.9 days, p = 0.01). The odds ratio of FWs for having a complicated disease was OR = 3.85 [95% CI: 1.38, 10.72], p = 0.01. Multivariate analysis identified FW and duration of symptoms as significantly contributing to a complicated disease outcome. Conclusions: Although duration of symptoms was comparable to the local population, FW in northern Israel are at increased risk for a complicated disease which resulted in longer hospital stay. Further studies may enlighten the reason for this disparity.

Original languageEnglish
Pages (from-to)2235-2240
Number of pages6
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number5
StatePublished - 7 May 2022


  • Acute appendicitis
  • Complicated appendicitis
  • Foreign workers
  • Israel

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine


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