Appendectomy in a large metropolitan hospital. Retrospective analysis of 1,013 cases

The finding of a normal appendix on appendectomy should occur in no more than 15 percent of patients, and in half of these some other cause of the abdominal pain will probably be found, most often gynecologic in origin. In order to achieve this rate, surgeons will have to exercise more restraint, develop greater discrimination in evaluating abdominal findings and probably spend more time palpating abdomens. This must be done while maintaining the incidence of perforation at or below 15 percent. A needless operation to remove a normal appendix is not an innocuous procedure and cannot be rationalized as such, but against this must be weighed the risks of delayed surgery when the history, physical findings and laboratory data are unequivocal. Future statistical reviews will tell how well surgeons are applying their skills in the evaluation of the troublesome vermiform appendix, and if there are any differences in the Health Maintenance Organization setting compared with the fee-for-service hospital.