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Background: Adult rates of ruptured appendicitis vary from 13.2 to 41.9 per cent in urban hospitals, despite controlling for individual factors. This suggests an effect of hospital organization. Surgeons report that appendicectomies may be delayed because of lack of access to operating rooms., Methods: Combining interviews with hospital personnel and information from medical records for 1998-1999, a cross-sectional study using logistic regression, taking hospital clustering of patients into account, was conducted on 861 patients from 12 hospitals. Hospitals were grouped into organizational models. The diagnostic information was recoded to ensure interhospital validity., Results: Hospitals with high activity and volumes of patients, but without an operating room designated for urgent surgery, were associated with a significantly higher risk of peritonitis (P<0.050). Time to surgery was very long in all hospitals, particularly time after departure from the emergency department and for elderly patients., Conclusion: Organizational characteristics, in unfavourable combinations, influence the course of time-dependent diseases such as appendicitis. Difficulties in gaining access to operating rooms, even for urgent operations, have emerged. Delays in treatment must be addressed when planning healthcare reforms., (Copyright (c) 2006 British Journal of Surgery Society Ltd.)

A response by P. Tousignant, N. Sicard, S. Dubé and R. Pineault to a letter to the editor about non-patient factors associated with rates of ruptured appendicitis in hospital patients is presented.

A response by N. Sicard, P. Tousignant, R. Pineault and S. Dubé to a letter to the editor about non-patient factors associated with rates of ruptured appendicitis in hospital patients is presented.