# Drivers of No-Show for Ambulatory Appendectomy at Kyabirwa Surgical Center, Jinja City, Uganda

## TL;DR

This study explores why half of patients scheduled for appendectomy at a Ugandan surgical center in Jinja do not show up, finding that cost concerns and fear of surgery are key factors.

## Contribution

The study identifies specific patient-level factors driving no-shows for ambulatory appendectomy in a low-resource setting.

## Key findings

- The no-show rate for appendectomy at Kyabirwa Surgical Center was 50%.
- Perceived high cost and tomophobia were significant drivers of no-shows.
- Access to transportation and affordability reduced the likelihood of no-shows.

## Abstract

Background

Appendicitis is a highly prevalent acute abdominal condition that has been increasing in prevalence since 1990. Millions of cases were registered in 2024 alone, along with thousands of deaths and more than a million disability-adjusted life-years. Such outcomes are inextricably associated with complicated appendicitis that has not been surgically treated. Sadly, a significant proportion of patients diagnosed with surgically treatable appendicitis and scheduled for appendectomy do not show up for surgery, even at standalone ambulatory surgery facilities where such surgery is comparatively cheaper.

Objective

This study aimed to assess the drivers of no-shows for ambulatory appendectomy at Kyabirwa Surgical Center (KSC), Jinja, Uganda.

Method

This cross-sectional study included 36 adult patients who were diagnosed with appendicitis at Kyabirwa Surgical Center and booked for an appendectomy between 2022 and 2025. The patients were consecutively sampled and engaged at the community level through structured interviews. Clinical data were abstracted and descriptively analyzed using SPSS version 26 (IBM Corp., Armonk, USA), along with a log-binomial model for multivariate analysis in the same program.

Results

The no-show rate for ambulatory appendectomies at Kyabirwa Surgical Center was 50% (18), although 67% (24)of all patients underwent appendectomy, with one-quarter (25%, 6) receiving it at other facilities. The perception of being able to afford an appendectomy without difficulty, having personal transportation to the facility, and access to transportation in general reduce the no-show rate. However, the perceived cost of appendectomy at Kyabirwa Surgical Center was high (unaffordable), and the fear of not waking up during surgery (tomophobia) increased the no-show rate.

Conclusion

The prevention of no-shows for appendectomy among patients at KSC is concerning; only half of the patients scheduled for that surgery appear at the center. One-quarter of them underwent surgery at other facilities, while the rest did not. This patient behavior is squarely linked to individual patient characteristics, largely tomophobia, and the perceived high cost of ambulatory appendectomies. In the future, the administration and staff of Kyabirwa Surgical Center may consider preoperatively educating and sensitizing all patients scheduled for ambulatory appendectomy or any ambulatory surgery about the comparatively lower cost of their ambulatory surgical procedures at Kyabirwa Surgical Center compared to other non-ambulatory facilities. This might help alleviate negative perceptions of the affordability of surgeries, such as appendectomies, which are at the center, thereby reducing no-show prevalence.