Morbidity and Mortality in Appendicitis in the Elderly

Abstract

Appendectomy is one of the most common surgical procedures. 1 The lifetime risk of developing appendicitis is higher in the second and third decades of life; it is 8.6% in males and 6.7% in females. 2 While acute appendicitis is primarily a disease of the younger population, 5-10% of the cases occur in the elderly population. The probability of developing appendicitis is increasing with the increase in the average life expectancy. 3 The diagnosis of appendicitis is primarily based on the history and physical examination. The differential diagnoses of acute appendicitis are significant. There may be a delay in diagnosis and treatment of elderly patients presenting with abdominal pain since they may have different clinical findings compared to those of younger patients. As a consequence, high morbidity and mortality can occur. 4 Prompt diagnosis and surgical referral will reduce the risk of perforation and prevent complications. Despite all these; in elderly patients, the risk of perforation due to appendicitis is up to 70% and the morbidity and mortality rates are 28-60% and 10%, respectively. 3 Therefore, an exact examination and avoidance of delayed diagnosis are highly important for morbidity and mortality.

Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study

“…It is interesting that there were no significant differences in the complication rates between open and laparoscopic surgery. Similar results are available in the literature [ 55 , 58 ]. Nevertheless, it is still recommended that the type of surgery chosen should be dependent on the relative experience of the surgeon with respect to the two methods [ 58 ].…”

“…Our data show a further increase in laparoscopic appendectomies over the observation period to 95% in 2017. This change from the open to the laparoscopic surgery is also described in the literature [ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. On the other hand, the conversion rate for open surgery was statistically constant and ranged only from 2.5 to 4.7%.…”

Case series: Treatment outcome of late presentation of acute appendicitis

“…Patient number 11 had self-medication without proper consultation with a healthcare worker. Number 10 and 11 were elderly and likely to have atypical results [17] . In ambiguous cases, aggressive diagnostic studies such as ultrasound or Computed Tomography (CT) Scan help increase the accuracy of diagnosis [17] .…”

Temporal Trends in the Investigation, Management and Outcomes of Acute Appendicitis over 15 Years in the North of England: A Retrospective Cohort Study

“…Differential diagnoses of RIF pain increase with age as often presentation can be vague. Previous literature indicates that CT is preferred to investigate as it improves diagnostic accuracy and reduces negative appendicectomy rates [ 43 ]. When surgery is chosen, it incurs longer operation waiting times and length of stay in hospital, which may reflect reluctance to operate or diagnostic challenges [ 43 ], reinforced by our findings.…”