BACKGROUND: The impact of socioeconomic status and distance to hospital on negative appendicectomy rates is unknown. These factors have been shown to be important predictors of health in a rural setting. OBJECTIVE: To determine whether socioeconomic status and road distance to hospital were risk factors for negative appendicectomy. METHODS: A retrospective analysis of all appendicectomies at a large rural hospital in Australia between January 2018 and December 2022 was performed. Patients' data were extracted from electronic medical records. Regression modelling was performed to determine whether socioeconomic status and road distance to hospital were risk factors for negative appendicectomy. The surgical outcomes for negative and positive appendicectomies were compared. RESULTS: A total of 830 patients were included in our analysis, of which 106 (12.8%) had negative appendicectomy. The rate of negative appendicectomy was not significantly impacted by socioeconomic status (OR = 1.004, 95% CI 0.989-1.20, p = 0.583) or road distance to hospital (OR = 1, 95% CI 0.998-1.001, p = 0.635). There was no significant difference in complications and 30-day readmission rates between patients in the negative and positive appendicectomy groups. CONCLUSIONS: In a rural setting, the risk of negative appendicectomy does not increase with lower socioeconomic status and longer road distance to hospital. This challenges the prevailing notion that rural surgeons have a lower threshold to operate on patients with lower socioeconomic status or who live further away from hospitals due to the perception that these patients have less access to healthcare.