Surgical treatment of acute appendicitis in older patients

Abstract

Introduction Acute appendicitis (AA) is the most common indication for emergency surgery and it occurs more often in children and young adults than in patients of advanced age. AA in older patients is a challenging surgical problem because of its atypical presentation. This study was performed to determine whether the age of a patient impacts the outcomes and whether laparoscopic appendectomy (LA) is a feasible method for treatment of patients > 65 years. Material and methods We performed a retrospective study of 355 patients with AA who were admitted to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn from 2014 to 2017. The patients were divided into three age groups: 18 to 40, 41 to 65 and >65 years. The histopathological diagnoses were divided into three types: simple AA, phlegmonous AA, and gangrenous AA. Results LA was performed in 96 % of young adults and in 67% of older patients. The patients older than 65 years had a higher preoperative white blood cell count counts, higher C-reactive protein (CRP) levels and had a longer length of stay (LOS) than younger patients (p=0.05, p=0.03, and p=0.03, respectively). We found a positive correlation among the CRP levels, open appendectomy (OA), and gangrenous appendicitis. Conclusions Patients older than 65 years more frequently underwent OA than LA, had higher preoperative CRP levels and had a longer LOS than did younger patients. Higher CRP levels were associated with a greater risk of gangrenous appendicitis. LA is a safe and feasible treatment method for patients older than 65 years.

Loss of Community‐Dwelling Status Among Survivors of High‐Acuity Emergency General Surgery Disease

“…For the present article, the requirement for operation within the first 2 calendar dates of admission was to confirm high acuity but not necessarily an immediately life‐threatening admitting diagnosis. In addition, primary diagnoses of appendicitis, cholecystitis, and simple soft tissue abscess, although noted to contribute to the overall national burden of EGS disease given their incidence, were excluded because they are typically well tolerated by most patients including those in older age groups . Our goal in defining a group of high‐acuity diagnoses was to focus on those older individuals at highest risk of debilitating outcomes.…”

“…In addition, primary diagnoses of appendicitis, cholecystitis, and simple soft tissue abscess, although noted to contribute to the overall national burden of EGS disease given their incidence, 29 were excluded because they are typically well tolerated by most patients including those in older age groups. [30][31][32] Our goal in defining a group of highacuity diagnoses was to focus on those older individuals at highest risk of debilitating outcomes. The 3-month inclusion time frame was selected to allow for 9 months of follow-up data for all subjects.…”

Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem

“…The rate of laparoscopies performed on the elderly varies significantly, ranging from 19.3% to 67% [ 12 , 31 , 46 , 51 ] depending on the year of the study (these are retrospective observational studies), but mainly depend on the preference of the surgeon.…”

Yaşli Hastalarda Laparoskopi̇k Ve Açik Apendektomi̇ni̇n Karşilaştirilmasi: Tek Merkez Deneyi̇mi̇

“…Several recent studies about the use of minimally invasive surgical methods have demonstrated the superiority of laparoscopic surgical methods over open surgery. 6 Th e use of laparoscopic methods over open surgery is currently increasing due to reasons such as reduced postoperative pain, shorter hospital stays, shorter time to return to daily life and fewer surgical site infections. 7 Acute appendicitis is a condition that usually aff ects the young population.…”