Well I suppose I'm jumping into the fray a bit late, but here I go, thanks to a bit of insomnia...
GoPens, you are oversimplifying surgical decision-making (as others have noted) and you are underestimating the potential for complications from seemingly uncomplicated disease processes.
Besides me, has anyone else had appendicitis? Who has experienced peritonitis? And less importantly, who has received an open appendectomy in the year 2000 simply because the available surgeon at the rural hospital near their college did not have laparoscopic skills or the hospital did not have the appropriate equipment?
Ok. Moving on then.
You seem to define the act of making a surgical incision as an inherently more reckless and risky endeavor in any situation where there are any other non-surgical options. The decision-making is quite a bit more complex than that and requires knowledge of the individual patient and their comorbidities, as well as the available facilities as the hospital.
Additionally, in accounting for costs in healthcare, you are neglecting to include an evaluation of length of stay and use of hospital resources.
A healthy young patient receiving a lap appy for uncomplicated appendicitis frequently leaves the hospital the same day (if surgery is performed in the morning) or is discharged the next morning on rounds. Their hospital stays are coded as "observation" for billing purposes and their insurance companies are billed as such - a significant cost savings over an inpatient admission, I assure you. A Tylenol tab costs $25 at the hospital in part because there is no line-item charge on the bill for nursing or nursing assistant care, for the pharmacist who dispenses it, for the tube system that delivers it from the pharmacy, etc etc etc. If all you need is Tylenol, it is much more cost effective and efficient to receive it at home.
If that same patient stays for antibiotics and observation to ensure their status does not decline, they are at the hospital for several days. A certain percentage will improve, but will have used up more hospital resources overall. The will also likely not return to work/productivity as quickly as those receiving surgery as their primary treatment and will have a lower risk of antibiotic-related illnesses such as C. Diff. The others will go on to require surgical intervention anyway. In a low-risk patient, the bias toward early surgery is sourced in the overall cost of treating the patient and the time to return to function and quality of life.
In a patient with comorbidities which elevate the risk of GETA and surgery, one might think that antibiotics would always be preferred for uncomplicated appendicitis. Unfortunately, that same patient is actually at greater risk if antibiotics are not effective and they eventually require surgical intervention. So we can cross our fingers that they are part of the percentage who improve with antibiotics alone, while hoping they do not decompensate to sepsis/complicated appendicitis and require surgical intervention when their surgical risk is even greater. Either way, you are, on average, increasing the LOS and use of hospital resources.
The above noted scenarios are all situations I have witnessed and none are "better" for the patient or the healthcare system/costs incurred against early surgery. Treating with antibiotics CAN be a viable option but it is beyond foolish to assume that the decision to do so is without risk or strain to the healthcare system.
Lastly, unless you have either HAD a surgical abdomen or cared for a significant number of patients who fall into that category, I would not be so hasty as to proclaim what treatment you would choose. No pain medication really totally controls the pain from peritoneal inflammation, localized or general. Unless you've languished for several days with fevers, anorexia, extreme fatigue and an inability to carry on with your daily activities due to an abdominal infection treated with antibiotics or have seen patients do the same, it is arrogance to baldly state what your choice would be. I have been on both sides of the doctor/patient paradigm with a surgical problem; neither the patient nor the surgeon should take the decision to operate lightly but it is pure egotism and arrogance to assume you can substitute the experience of either for what you learned in the first 2 years of medical school.
