What have we learned over the past 20 years about appendicitis in the elderly?
BACKGROUND
This study evaluates appendicitis in the elderly, comparing our findings to those previously published a decade earlier.


METHODS
Comparison of appendicitis in the elderly (aged 60 years and older) from 1978 to 1988 with the following 10 years, 1988 to 1998.


RESULTS
Overall (1978-1998) 26% of patients presented typically, one third delayed seeking care, with only half diagnosed correctly on admission. Computed tomography (CT) use increased (44% versus rarely in the previous decade). Perforation rates declined (72% first group versus 51% second group) with a concomitant drop in complications from 32% to 21% respectively. Overall, three fourths of complications occurred in patients with perforated appendicitis. Mortality rates remained constant.


CONCLUSIONS
Appendicitis in the elderly is a difficult problem with delays in medical care, non-typical presentation resulting in incorrect diagnosis, relatively high rates of perforation often with associated postoperative complications and mortality. A higher index of suspicion with liberal early utilization of CT in uncertain cases may result in more appropriate management.
Storm-Dickerson
Toni L
TL
Department of General Surgery, Akron General Medical Center, 400 Wabash Ave., OH 44307, USA.
Horattas
Mark C
MC
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed