Billing Data Cannot Answer the Study Question

Stöß et al. analyzed data from diagnosis-related group statistics and concluded (1) that acute appendicitis is increasingly treated conservatively in Germany. This statement remains pure speculation, however, since it is not confirmed in the chosen study design nor in the presented figures, because they did not analyze data on conservative treatment. The selected indicators for a complicated disease course are removed from reality. Transfusion of ≥ 6 units of blood or mechanical ventilation >24 h are no suitable outcome parameters in appendectomy, and neither is mortality. Speculatively it should be discussed whether the true complicated courses are actually documented in the analyzed population. This relates to patients with numerous (and not only one) procedure such as diagnosis-related group–relevant subsequent bowel resections, vacuum-assisted closure treatments, and adhesiolysis. Such patients do not meet the inclusion criteria for the study.

Appendicitis is a surgically relevant disease; the indication for surgery is defined by taking a careful history and subtle clinical examination. Complicated courses are usually the result of delayed surgery. In selected cases conservative treatment is obviously justified, but this must not lead to any delay to a potentially necessary appendectomy. This is a very interesting and relevant clinical question, but in all certainty it cannot be answered on the basis of billing statistics.