Acute appendicitis: a descending trend?
OBJECTIVE
The diagnosis-related group (DRG) system is a prospective hospital payment system used to categorize hospital patients expected to require similar hospital services. In Italy, hospital productivity is calculated from DRG-based data coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), which is a classification system for coding of diagnoses and operations for indexing medical records by diagnosis and operations. The aim of our survey was to determine the national incidence of appendectomies based on the coded summary of selected data in hospital discharge reports (HDR).


METHODS
The Italian Ministry of Health online database was searched for data collected between 2001 and 2003. The search engine allows analysis by different regions but not by individual hospital. The national incidence of appendectomy was calculated using data collected from the ICD-9-CM and from the HDR. In a deeper analysis, regional data and data from individual hospitals were compared.


RESULTS
The analysis revealed the incidence of appendectomy, rates of simple acute appendicitis vs complicated appendicitis, common laparotomic appendectomy vs laparoscopic appendectomy, as well as mean duration of hospitalization.


CONCLUSIONS
The incidence of acute appendicitis has considerably decreased, whereas the rates of complicated appendicitis have increased because of longer diagnostic and therapeutic delay, inappropriate antibiotic therapy and upclassifying of diagnosis and procedures in the HDR (ICD-9-CM) in order to obtain a ''wider impact'' on DRG.
Cirocchi
R
R
General Surgery and Emergency Clinic, Hospital S. Maria, Terni, University of Perugia, Italy. cirocchiroberto@yahoo.it
Morelli
U
U
La Mura
F
F
Cattorini
L
L
Napolitano
V
V
Galanov
I
I
Covarelli
P
P
Giustozzi
G
G
Sciannameo
F
F
D000208:Acute Disease; D001062:Appendectomy / Q000379:methods / Q000639:trends; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D003625:Data Collection; D003953:Diagnosis-Related Groups; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D016896:Treatment Outcome