The impact of multilevel referral system in patients with peritonitis in Indonesia: A cross-sectional study

Background: Peritonitis requires emergency surgery, and delays in treatment can lead to death. We aimed to determine the correlation between the periods from onset to hospital admission with postoperative mortality for patients with peritonitis and to compare it with the effect of national health insurance implementation. Methods: This study was a cross-sectional study conducted at a tertiary health center in Indonesia. We ascertained 150 patients with peritonitis from January 2012–December 2015. Results: One hundred and fifty patients were ascertained, including 72 patients before National Health Insurance (NHI) era and 78 patients after the NHI era (Males: 90 vs females: 60). The most frequent age group was age 46–65 years (44.67). The period between onsets to hospital mainly occurred within 24–72 h (42). Most of the patients had some comorbidity with one or more diseases (52.67). Mortality was found in as many as 61 people (40.67). The highest etiology of peritonitis was appendix perforation (28) and gastric perforation (22). Mortality was most common in the period between onset to time treated within 24–72 h (N:35; 23.33) (P < 0.05). Before the NHI era, the period between onset to time treated was mostly after > 72 h (18.66), whereas after the NHI era it was mostly within 24–72 h (25.33) (p < 0.05). Conclusion: The multilevel referral system implemented in the NHI era significantly affects the time-to-treat and outcome of patients with peritonitis. © 2020 The Authors