Poor access to surgical care affects acute appendicitis outcomes in low-density regions.

• 23.2% of patients aged 65+ from low-density areas had complicated appendicitis.
• Patients in low-density regions had a 27.7% rate of traveling 50 km or more for care, versus 2.5% in high-density areas.

Surgeons must consider regional access disparities in patient selection and management strategies for appendicitis.

• 39.3% of patients in low-density areas were transferred from other hospitals, highlighting referral system challenges.