title: Management and outcome of appendicitis among octogenarians in an English hospital over a five year period.
abstract: BACKGROUND
  There is a different perspective on diagnosis and management of common surgical problems in elderly patients. This study aimed to analyse the management of acute appendicitis in octogenarians.
  
  
  METHODS
  A retrospective study investigated all appendicectomies over five years. Patient records were studied for presenting features, pre-operative imaging, pre-operative ASA grade, site of incision, post-operative complications and length of inpatient stay.
  
  
  RESULTS
  Presenting symptoms included lower abdominal pain (n = 31, 93.9%), anorexia (n = 19, 57.6%), nausea and vomiting (n = 15, 45.5%) and shifting pain (n = 10, 30.3%). Twenty patients had right iliac fossa pain (60.6%) and seven had pyrexia (21.2%). The commonest co-morbidity was cardiac (n = 19; 58%). The average time from admission to theatre was greater in octogenarian patients (1.24 ± 0.90 days) than other patients (0.64 ± 0.71 days), as was the average length of stay at 11 ± 2.6 days compared with 4.3 ± 3.1 days. The majority of octogenarian patients received a Lanz incision (48.3%), with others receiving laparotomy (24.1%), lower midline (13.8%), gridiron (13.8%), and right paramedian (3.4%). Complications were more common in the octogenarian patients (63.6%) than other patients (22.55%). The most common complications in the octogenarian population were post-operative ileus (n = 7; 21%), wound infection (n = 5; 15.2%) and pneumonia (n = 5; 15.2%).
  
  
  CONCLUSIONS
  Appendicitis in the elderly can result in significant morbidity due to the atypical presentation causing an unnecessary delay in treatment. If indicated, age should not be a contraindication for an appendicectomy. The increased likelihood for these patients to have a post-operative complication should be at the forefront of their care.
authors: Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex, BN1 9PX, UK. d.mcgowan1@uni.bsms.ac.uk
authors: D R
authors: DR
authors: McGowan
authors: M H
authors: MH
authors: Howlader
authors: R
authors: R
authors: Patel
authors: N
authors: N
authors: Swindlehurst
authors: D
authors: D
authors: Manifold
authors: I
authors: I
authors: Shaikh
mesh_terms: D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D004739:England; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies