title: Acute appendicitis in the octogenarians and beyond: a comparison with younger geriatric patients.
abstract: BACKGROUND
  Difference of the clinical characteristics and outcome of acute appendicitis (AA) between young old (age 60 to 79 years) and octogenarian patients (age 80) is unknown. We hypothesized that octogenarian patients would have more atypical presentation and worse outcomes.
  
  
  METHODS
  Our study was a 10-year retrospective analysis of a hospital based database. All patients with histopathologically confirmed AA from 1995 to 2005 registered in this database were selected for study. Demographic data, preexisting conditions, clinical manifestations, Alvarado score, delay in surgery, complications, and mortality were compared between the octogenarians and young old. Independent effect of age on outcomes was examined by logistic regression model controlling for sex, comorbidities, and time delayed for surgery.
  
  
  RESULTS
  Octogenarian patients constituted 93 (14.8%) of 628 geriatric patients with AA. On clinical manifestations, migrating pain and localized iliac fossa tenderness were less common in the octogenarians. Low sensitivity of Alvarado score in diagnosing AA was noted in both young old (50.7%) and octogenarian (44.1%) patients. Compared with young old patients, octogenarians had a longer delay in surgery and worse outcomes. Octogenarians had a significantly higher perforation rate (65.6% vs 49.5%, P < 0.001), postoperative morbidity rate (18.3% vs 10.1%, P < 0.001), and mortality rate (6.5 % vs 1.5 %, P < 0.001). Octogenarian age was independently associated with appendiceal perforation (OR, 95% CI; 1.94, 1.23 approximately 3.08), postoperative morbidity (2.0, 1.10 approximately 3.62), and mortality (4.5, 1.54 approximately 13.41).
  
  
  CONCLUSIONS
  The clinical presentation of AA in octogenarian patients is atypical and the outcomes are worse than young old patients.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Taoyuan, Taiwan.
authors.forename: Yui-Rwei
authors.initials: YR
authors.lastname: Young
authors.forename: Te-Fa
authors.initials: TF
authors.lastname: Chiu
authors.forename: Jih-Chang
authors.initials: JC
authors.lastname: Chen
authors.forename: Meng-Sheng
authors.initials: MS
authors.lastname: Tung
authors.forename: Meng-Wei
authors.initials: MW
authors.lastname: Chang
authors.forename: Jung-Hsiang
authors.initials: JH
authors.lastname: Chen
authors.forename: Bor-Fuh
authors.initials: BF
authors.lastname: Sheu
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome