The worse the appendicitis, the more it costs everyone—the patient, the physician, and the health care system. The time has come to change the prevention, reporting, and payment.
In this issue of JAMA Surgery, Anandalwar et al1 are to be congratulated for shining the light of rigorous analysis on something that every surgeon knows intuitively: the worse the operative findings, the sicker the patient. If a patient has a belly full of pus and stool in the pelvis, he or she is in for a prolonged length of stay and multiple complications, most of which are out of the control of the surgeon.