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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.