Surgical decision-making on appendicitis: a comparison between Sweden and China

Main Article Content

Nicolina Söderlind Åke Andrén-Sandberg Gabriel Sandblom


Background: although diagnostic criteria for appendicitis are well- defined, the indications for performing appendectomy are still vague. This implies that the decision-making process differs between surgeons, hospitals and countries. Healthcare in China has developed over the last two decades, and is in many respects comparable to western countries, though there still exists room for improvement. To explore how medical decision-making works in China, and whether or not their medical results are applicable to the Western setting, we compared the indications for appendectomy in China with those in Sweden.

Objective: to investigate decision-making on appendectomy in Sweden and China.

Methods: a retrospective evaluation of all appendectomy procedures at the Karolinska Hospital in 2009 formed the basis of a questionnaire. Using this questionnaire, a prospective study was coinducted at Södersjukhuset and Karolinska University Hospital Stockholm in 2010 and at Taizhou hospital in 2013. The decision-making surgeon reported which factors were present at the time of treatment decision, and which factors had the greatest impact on their decision.107 questionnaires were collected in China and compared to 117 collected in Sweden.

Results: the most frequently reported factors in Sweden and China were similar, but there were some differences. Tenderness in the right fossa had a great impact on the decision to operate in both countries, but an interesting difference was that there was a greater tendency to rely on image diagnostics in Sweden.

Limitations: further investigation is needed to evaluate how decision-making is related to evidence and how this affects outcome.

Conclusions: as regards appendicitis, the decision-making process in China is similar enough to allow results from China to be used in the Western setting.

Article Details

How to Cite
SÖDERLIND, Nicolina; ANDRÉN-SANDBERG, Åke; SANDBLOM, Gabriel. Surgical decision-making on appendicitis: a comparison between Sweden and China. Medical Research Archives, [S.l.], v. 4, n. 8, dec. 2016. ISSN 2375-1924. Available at: <>. Date accessed: 30 jan. 2023.
Appendicitis; Decision-making; Diagnosis; Surgery; Health economy
Research Articles


1. Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA. 1996;276(19):1589-94.
2. Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, et al. Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials. Dig Surg. 2011;28(3):210-21.
3. Andersson RE. Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis. World J Surg. 2012;36(7):1546-7.
4. Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009;169(20):1881-7.
5. Schiff GD. Minimizing diagnostic error: the importance of follow-up and feedback. Am J Med. 2008;121(5 Suppl):S38-42.
6. Croskerry P, Nimmo GR. Better clinical decision making and reducing diagnostic error. J R Coll Physicians Edinb. 2011;41(2):155-62.
7. Diener MK, Wolff RF, von Elm E, Rahbari NN, Mavergames C, Knaebel HP, et al. Can decision making in general surgery be based on evidence? An empirical study of Cochrane Reviews. Surgery. 2009;146(3):444-61.
8. Wang C, Rao K, Wu S, Liu Q. Health care in China: improvement, challenges, and reform. Chest. 2013;143(2):524-31.
9. Liu X, Liu Y, Chen N. The Chinese experience of hospital price regulation. Health Policy Plan. 2000;15(2):157-63.
10. Lin W, Liu GG, Chen G. The Urban Resident Basic Medical Insurance: a landmark reform towards universal coverage in China. Health Econ. 2009;18 Suppl 2:S83-96.
11. Sandell E, Berg M, Sandblom G, Sundman J, Fränneby U, Boström L, Andrén-Sandberg Å. Surgical decision-making in acute appendicitis. BMC Surg. 2015 Jun 2;15:69.
12. Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31(1):86-92.
13. Ellis H. Acute appendicitis. Br J Hosp Med (Lond). 2012;73(3):C46-8.
14. Paulson EK, Kalady MF, Pappas TN. Suspected Appendicitis. New England Journal of Medicine. 2003;348(3):236-42.
15. Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147(3):318-30, 30 e1-6.
16. Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013;100(3):322-9.
17. Panagiotopoulou IG, Parashar D, Lin R, Antonowicz S, Wells AD, Bajwa FM, et al. The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Ann R Coll Surg Engl. 2013;95(3):215-21.
18. Doria AS. Optimizing the role of imaging in appendicitis. Pediatr Radiol. 2009;39 Suppl 2:S144-8.
19. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012;10(3):115-9.
20. Prystowsky JB, Pugh CM, Nagle AP. Current problems in surgery. Appendicitis. Curr Probl Surg. 2005;42(10):688-742.