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Invited Critique
July 2002

The Clinical and Economic Correlates of Misdiagnosed Appendicitis—Invited Critique

Arch Surg. 2002;137(7):804. doi:10.1001/archsurg.137.7.804

The mere act of the well-intended surgeon knowingly removing a normal appendix is of no immediate therapeutic benefit to the patient diagnosed as having appendicitis. This of course is always predicated on clinical and, more often than not, imaging information that suggest appendicitis.

A "negative appendectomy"—removal of an uninflamed appendix in a patient with a clinical diagnosis of appendicitis—results in an average length of hospital stay of 5.8 days, a charge of $18 825, a fatality rate of 1.5%, and an infectious complications rate of 2.6%. If the surgeon removes an inflamed appendix in a patient with the same clinical diagnosis, the respective values are more favorable at 3.6 days, $10 535, 0.2%, and 1.8%. The annual cost of a negative appendectomy to the health system is calculated to be $742 million.