In Reply

Letters to the Editor Acute Appendicitis: Trends in Surgical Treatment A Population-Based Study of Over 800 000 Patients by Dr. med. sci. Christian Stöß, PD Dr. med. Ulrich Nitsche, PD Dr. med. Philipp-Alexander Neumann, Dr. rer. nat. Victoria Kehl, Prof. Dr. med. Dirk Wilhelm, Prof. Dr. med. Reinhard Busse, Prof. Dr. med. Helmut Friess, and Dr. PH Ulrike Nimptsch in issue 14/2021

As we explained in the abstract of our article (1), ours is a purely descriptive study that showed that the number of diseases coded to the ICD-code “acute appendicitis” and the number of procedures coded to “appendectomy” of the Operationen- und Prozedurenschlüssel (Operation and Procedure Classification System—the German modification of the International Classification of Procedures in Medicine)—are both following a downward trend. It is indeed only a matter of assumption that treatment is increasingly conservative, in the sense of sole antibiotic therapy (with or without interventional percutaneous drainage)—as we discussed in our article. What cannot be debated away, however, is a 9.8% decrease in appendectomies in Germany. One indication and an approximation to clinical scenarios lies in the fact that the numbers of appendectomies for acute, complicated appendicitis rose in the study period. We did not analyze conservative therapeutic approaches because this might have led to double counting (in contrast to appendectomy, which is possible only once per patient). The selected surrogate parameters to show a clinically complicated course relate to very severe courses, but follow established measures in the possible context of an evaluation of diagnosis related groups (2). Our inclusion criteria continue to include patients with follow-on procedures during the same hospital stay. The present study cannot serve as a carte blanche for conservative treatment of acute appendicitis; rather, it mirrors trends in surgical therapy of appendicitis over recent years in Germany (3). Furthermore, the aim of the study was not only to show numbers of appendectomies but especially to focus on differences in surgery rates, morbidity, and mortality between uncomplicated and complicated appendicitis.

DOI: 10.3238/arztebl.m2021.0249

On behalf of the authors

Dr. med. sci. Christian Stöß

Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik
für Chirurgie, Technische Universität München

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

References

1. Stöß C, Nitsche U, Neumann PA, Kehl V, Wilhelm D, Busse R, et al.: Acute appendicitis: trends in surgical treatment—a population-based study of over 800 000 patients. Dtsch Arztebl Int 2021; 118: 244–9

2. Nimptsch U, Spoden M, Mansky T: [Definition of variables in hospital discharge data: pitfalls and proposed solutions]. Gesundheitswesen 2020; 82: 29–40.

3. Collaborative C, Flum DR, Davidson GH, et al.: A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med 2020; 383: 1907–19