Acute Appendicitis in the Elderly in the Twenty-First Century

Segev, Lior; Keidar, Andrei; Schrier, Ilan; Rayman, Shlomi; Wasserberg, Nir; Sadot, Eran

doi:10.1007/s11605-014-2716-9

Cited by 53 publications

(50 citation statements)

References 25 publications

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“…Duration of symptoms untill admission to the hospital varies between 1.6-2.08 days (19)(20)(21). Our findings were higher than literature with 3.2 days.…”

Section: Discussioncontrasting

confidence: 64%

“…Our operation time (57.98 minutes) was found to be shorter than most of the literature findings (78.3-88 minutes) (20,21,26). This was a result of lower laparoscopic appendectomy rates (6.6% only) of our study.…”

Section: Discussioncontrasting

confidence: 59%

“…This was a result of lower laparoscopic appendectomy rates (6.6% only) of our study. The mean length of hospital stay was found only 3.89 days that is also shorter than recent studies (20,21,26). We found that perforation of the appendix increases mortality rates and complications.…”

Section: Discussioncontrasting

confidence: 50%

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Retrospective cohort study of elderly patients with acute appendicitis

Arer¹,

Kus²,

Akkapulu³

et al. 2017

J Turgut Ozal Med Cent

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Aim: Appendicitis is the most common surgical cause of abdominal pain among the patients being admitted to Emergency department. Although it affects younger patients, its incidence increases in elderly as the population gets older. Higher perforation and complication rates have been reported in elderly patients. The aim of this study is to investigate appendicitis in patients older than 65 years. Material and Methods: A total of 61 patients with performed appendectomy older than 65 years age were included in this study. Laparoscopic and open appendectomies were included. Data were collected retrospectively. Patients were analyzed according to demograhic data, operative findings, complications and mortality. Results: Of 61 patients, 34 (55.7%) were male and 27 (44.3%) were female. The mean age was found to be 71.59 years. The average duration of symptoms were 3.2 days. Laparoscopic appendectomy was performed in only 4 (6.6%) patients. The mean hospital stay was found to be 3.89 days. Complications were found in 13 (21.3%) patients. Mortality was found to be 3.3%. Perforated appendicitis was found to be associated with physical findings, CRP level and hospital stay (p<0.05). Abdominal ultrasound has a sensitivity of 45.2% and specificity of 66.7% and computerized tomography has higher sensitivity (82.1%) and specificity (100%). Conclusion: Prompt diagnosis and treatment should be performed in the elderly patients with suspected appendicitis in order to prevent complications and mortality. Radiological modalities should be used to ensure accurate diagnosis of appendicitis in elderly patients.

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“…Duration of symptoms untill admission to the hospital varies between 1.6-2.08 days (19)(20)(21). Our findings were higher than literature with 3.2 days.…”

Section: Discussioncontrasting

confidence: 64%

Section: Discussioncontrasting

confidence: 59%

See 1 more Smart Citation

Retrospective cohort study of elderly patients with acute appendicitis

Arer¹,

Kus²,

Akkapulu³

et al. 2017

J Turgut Ozal Med Cent

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“…The non-surgical approach is an effective strategy for managing appendiceal abscess in children and adults [10][11][12][13] . The success rate of this approach is relatively high, ranging from 80% to 95% 2,3) .…”

Section: Discussionmentioning

confidence: 99%

Prediction of Negative Outcomes in Non-Surgical Treatment for Appendiceal Abscess in Adults

Sadakari

Date

Murakami

et al. 2018

J Anus Rectum Colon

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Abstract:Objectives: Non-surgical treatment is an acceptable approach for managing appendiceal abscess in adults. However, it is only applicable for selected patients, and conversion to surgery is mandatory for failed conservative treatment. This study aimed to determine the predictive factors for unsuccessful outcomes. Methods: Of 594 patients with acute appendicitis, 34 (5.7%) diagnosed with appendiceal abscess were initially treated conservatively. Patients were divided into two groups: the conservative group, which was successfully treated with antibiotics and percutaneous abscess drainage, and the conversion group, which comprised patients who had surgical conversion despite conservative treatment. Risk factors for the conversion group were investigated by comparing clinical and radiological parameters between the two groups. Results: Eight (23.4%) patients were converted to surgical management at an average of 5.5 days of non-surgical treatment. An abscess size greater than 40 mm and a lower rate of improvement in the white blood cell (WBC) count were significant factors for predicting conversion in multivariate analysis. The conversion group had a long operative time and high morbidity and operative conversion rates (change of proposed initial operation). Early conversion to operation group, i.e., less than 5 days of treatment, contributed to a significantly shorter hospital stay, lower hospital cost, and relatively shorter operative time (p = 0.02, p = 0.04, and p = 0.11, respectively). Conclusions: Contributing factors in predicting unsuccessful outcomes for nonsurgical treatment include an abscess size greater than 40 mm and a low rate of improvement in WBC count on the first day of antibiotic treatment.

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“…Predpostavljali smo, da obstaja več zapletenih vnetjih pri starejši populaciji kot pri mlajši (6,7). Opazovali smo tudi zapletenost vnetij glede na mesec v letu, pri čemer nas je zanimala morebitna sezonska korelacija.…”

Section: Uvodunclassified

Primerjava laparoskopske apendektomije pri enostavnem in zapletenem vnetju slepiča

2017

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IzvlečekIzhodišča: Laparoskopska apendektomija se vse bolj uveljavlja kot metoda izbire za kirurško zdravljenje vnetja slepiča. Pri zapletenih vnetjih pa so mnenja deljena. Poročajo namreč o višjem odstotku konverzij, daljšem času operacije, večji pojavnosti abscesov in daljši hospitalizaciji. Cilj naše študije je bil primerjati način diagnosticiranja, zdravljenja in zapletov pri enostavnih vnetjih slepiča z zapletenimi.Metode: V naši ustanovi je laparoskopska apendektomija metoda izbire kirurškega zdravljenja vseh oblik akutnega vnetja slepiča. V retrospektivno raziskavo smo vključili vse bolnike z akutnim vnetjem slepiča, ki so bili operirani v letu 2013 in 2014 v Splošni bolnišnici Izola. Izmed 273 jih je bilo iz analize izključenih 19 bolnikov, ki so bili operirani primarno s klasično tehniko in 1 bolnik, ki je bil po operaciji ponovno kirurško obravnavan z apendektomijo. Tako smo pri 253 bolnikih spremljali delež zapletenih vnetij glede na starost, mesec v letu, čas hospitalizacije, diagnostične metode, dreniranje trebušne votline, delež konverzij, način oskrbe krna in delež pooperativnih zapletov.Rezultati: Analiza rezultatov je pokazala strmo rast deleža zapletenih vnetij pri starejši populaciji, glede na mesec v letu pa ni bilo statistično pomembnih razlik (test hi-kvadrat, p = 0,158). Čas hospitalizacije je bil pri zapletenih vnetjih daljši (3,49 v. 5,94 dni). Pri tistih, ki so imeli pred operacijo opravljen CT, je bil delež zapletenih vnetij višji (CT 0,654, brez CT 0,229; test hi-kvadrat, p < 0,001). Delež dreniranj je bil pomembno višji (enostavno vnetje 0,223, zapleteno 0,855; test hi-kvadrat, p < 0,001). Delež enostavnega zapiranja krna s klipi je bil pri enostavnih vnetjih pomembno višji (enostavno vnetje 0,717, zapleteno 0,521; test hi-kvadrat, p = 0,005), pri deležu zgodnjih zapletov po operaciji in deležu konverzij pa ni bilo statistično pomembnih razlik.Zaključki: Z našo raziskavo smo ugotovili, da obstajajo razlike pri diagnosticiranju in zdravljenju glede na stopnjo vnetja slepiča, nismo pa ugotavljali statistično pomembne razlike v deležu konverzij ali zapletov po operaciji. Iz naših ugotovitev izhaja, da je laparoskopska apendektomija varna metoda pri vseh oblikah vnetja slepiča. AbstractBackground: Laparoscopic appendectomy has been gaining ground as a gold standard for the treatment of acute appendicitis. For complex inflammation there is no common opinion. A higher conversion rate, longer operative time, higher incidence of abscess formation and longer hospitalization are being reported. The aim of our study was to compare the diagnostic modalities, treatment and postoperative complications in uncomplicated and complicated appendicitis.

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Acute Appendicitis in the Elderly in the Twenty-First Century

Cited by 53 publications

References 25 publications

Retrospective cohort study of elderly patients with acute appendicitis

Retrospective cohort study of elderly patients with acute appendicitis

Prediction of Negative Outcomes in Non-Surgical Treatment for Appendiceal Abscess in Adults

Primerjava laparoskopske apendektomije pri enostavnem in zapletenem vnetju slepiča

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