Acute appendicitis in the elderly patient: diagnostic problems, prognostic factors and outcomes.
OBJECTIVE
Acute appendicitis (AA) in the elderly (over 60 year-old) continues to pose diagnostic problems and carries a high morbidity and mortality rate. The aim of this article is to present our experience and outcomes and to evaluate influencing factors.


METHODS
During a period of 5 years 63 patients with a definitive pathological diagnosis of AA were retrospectively analyzed.


RESULTS
The primary admission diagnosis was established correctly in 44 patients (69.8%). Nineteen patients (30.1%) required further diagnostic investigations and the mean time to final diagnosis was 26 hours. For 3 patients (4.8%), the final diagnosis was established intra-operatively. The perforation rate was 31.8% (20 patients). Thirty-eight patients (63.3%) had associated co-morbidities. The overall mean duration of pre-hospitalization symptoms was 2.7 days, 2.3 days for non-perforated cases and 3.8 days for perforated AA (p=0.0025). The complication rate was 34.9% (22 patients), complications occurred in 75% of perforated appendicitis and in 16.2% of non-perforated cases (p=0.00001). Overall mortality rate was 6.3%, 15% in the perforated case group and 2.3% in the group with non-perforated appendicitis (p=0.0003). The mean hospital stay was significantly longer for cases with perforated AA (7.2 days) than non-perforated AA (5.1 days) (p=0.0056), and for patients developing complications (9.6 days) than those without complications (5.6 days) (p=0.0031).


CONCLUSIONS
Advanced age adversely affects clinical diagnosis, the stage of the disease and the outcomes. Late presentation, delayed diagnosis, presence of perforation and co-morbidities are associated with a poor outcome from surgery.
Lunca
Sorinel
S
Emergency Surgical Clinic, University of Medicine and Pharmacy "Gr. T. Popa" Iaşi, Romania. slunca@hotmail.com
Bouras
George
G
Romedea
Narcis Sandy
NS
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome