Appendicitis in the elderly.
BACKGROUND
Acute appendicitis in the elderly (i.e. those over 60 years of age) is associated with high morbidity and mortality rates. The present retrospective study reviews 10 years ( 1986-1996) of experience and outcome in treating acute appendicitis in patients aged 60 or above.


METHODS
One hundred and thirty patients with acute appendicitis were identified and their case notes reviewed.


RESULTS
Acute appendicitis was diagnosed at admission in 84 patients (64.6%). The remaining patients were observed for a median duration of 9.4 h prior to diagnosis and treatment. Patients with an underlying perforated acute appendix had a significantly longer period of pain prior to admission (P = 0.029; Mann-Whitney U-test) but perforation per se was not associated with a significantly higher rate of morbidity and longer length of hospital stay. In contrast, the use of midline or paramedian incisions was associated with a higher wound infection rate (P=0.003; Pearson chi-squared test) and a longer hospital stay (P<0.001; Mann Whitney U-test). None of the patients were subsequently found to have an underlying colonic neoplasm. The overall morbidity rate was 28%. The mortality rate was 2.3% and all three patients who died had a severe comorbid medical condition prior to developing acute appendicitis.


CONCLUSIONS
Acute appendicitis in the elderly is still associated with significant morbidity. But once acute appendicitis is diagnosed, then expedient surgery, appropriate use of perioperative antibiotics and a right lower quadrant incision can help to minimize the morbidity. Pre-existing severe comorbid medical condition(s) is a major contributory factor to mortality in these patients.
Lee
J F
JF
Chinese University of Hong Kong, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong.
Leow
C K
CK
Lau
W Y
WY
D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents