In 1978, acute appendicitis care was reviewed by studying 2,375 cases from 74% of all hospitals in Wisconsin outside the greater Milwaukee area. The mortality was 0.17% and the wound complication rate was 5.3%. A normal appendix report was noted in 14% of all cases; female patients accounted for 60% of these cases, and only 44.5% of the total study population. The rupture or perforation rate was 13.4%; 62% of these problems occurred in male patients. The mean hospital stay was 5.4 days; for perforated cases, it was 10.2 days. An analysis that compared hospitals by their individual ratios of normal appendices to perforations favors the conclusion that a small but real decrease in negative appendectomy rates could be achieved without producing more ruptures or perforations.