Thank you for the opportunity to respond to Dr Ammori's letter regarding our study. I agree with Dr Ammori that our article describes the economic and clinical implications of conditions that are treated with (among other things) appendectomy rather than the cost of the procedure itself. He suggests that patients who undergo NA might better be described as having NSAP. The problem with this distinction is that NSAP is a post hoc assessment most often made after patients have had their normal appendix removed. In the current medical lexicon, a 25-year-old man with right lower quadrant abdominal pain is usually diagnosed as having presumed appendicitis rather than NSAP. The clinical and financial costs we carefully detailed not only represent the cost of the appendectomy but also include the further diagnostic and therapeutic costs of the condition (specific or nonspecific) that was masquerading as appendicitis.
Flum DR. The Clinical and Economic Correlates of Nonspecific Abdominal Pain Mismanaged by Appendectomy—Reply. Arch Surg. 2003;138(1):111. doi:10.1001/archsurg.138.1.111