The high rate of appendectomy in Japan

During the past 25 years in Japan, a change has occurred in the number of appendectomies performed. The results of an investigation in a private (N) hospital showed that 63 per cent of the operations was for "catarrhal appendicitis" that had no inflammatory findings. This "catarrhal type" was found at the highest level in young women. We also investigated the rate of appendectomy by age, and computed the yearly rate increase. It was found that a significant increase in the operation rate began about 1950, and the annual rate thereafter amounted to about 0.75 per cent-or about threefold that in England. This annual increase was attributed to the number of cases in which no inflammation was found in the operated appendix. We discussed the cause and concluded that this high rate of appendectomy is believed to be secondary to the fee-for-service system in the medical insurance programs that were instituted in Japan after World War II.