Acute appendicitis is a common malady, affecting more than six hundred eighty thousand Americans each year. Despite advances in diagnostic technology, establishing the correct diagnosis of appendicitis remains problematic, resulting in a significant rate of negative surgical interventions. In an effort to gain insight into changes in management over the last half century, we compared data gathered in a single metropolitan region in 1955 to recent time. Data from hospitals in a single metropolitan area were collected by the local Surgical Society in 1955, recorded and preserved. Recently, we collected data from hospitals in the same region, excluding the pediatric hospital, on all patients undergoing appendectomies. Patient demographics, diagnostic tests, type of surgery, and pathological and clinical outcomes were recorded. Statistical signifigance was analyzed using a Students T test. A total of 2096 appendectomies were studied. In 1955, 1123 appendectomies were recorded and in 2004, 973. The negative exploration rate decreased from 16.9%. to 5.9% (p<.05). Percentage female (60%), and age at diagnosis were similar. Mortality improved significantly (0.0 vs. 0.35%, p < 0.5). In 1955, more patients had other pathology at the time of exploration compared to now. (6.0% vs. 0.5%). Recent data showed 90% of patients underwent a CT Scan, 55% underwent surgery by laparoscopy, however the rate of laparoscopy varied widely among the institutions. The current average hospital stay was 1.6 days. The positive predictive value of a CT Scan was 86%, with a false negative rate of 1.0%. The diagnosis of acute appendicitis remains a common surgical dilemma. Currently, most patients undergo a CT Scan as a predictive tool and many patients undergo a laparoscopic procedure. The modern error rate of 5.9% is significantly improved compared to the rate of 50 years ago of 16.9%, and now, other pathology is rarely discovered. Mortality from acute appendicitis is uncommon.