Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience.
BACKGROUND
Only 5-10% of cases of acute appendicitis (AA) are diagnosed above the age of 60 years. Complicated AA is more common in the elderly, who also have more comorbidities. The goals of this study were to describe our experience with elderly patients and identify predictors of increased morbidity.


METHODS
Patients ≥65 years who were treated for AA between 2006 and 2013 were selected. The control consisted of patients aged 20-45 years, who were randomly selected from a pool of 900 patients.


RESULTS
Seventy-four patients ≥65 years, mean age of 74.6 ± 7.4, were included. Time from onset of symptoms to surgery was similar between the groups. CT scan was performed for all patients in the elderly group compared to 55.6% in the younger group (p < 0.001). 77% of the younger patients underwent laparoscopic appendectomy compared to 43.2% of the elderly patients (p < 0.001). Pathological findings of severe appendicitis were significantly more common in the elderly group (39.2 vs. 10.5%, p < 0.001). Sixteen elderly patients (21.6%) developed complications, compared with 4 patients (3.2%) in the younger group (p < 0.001). The length of stay was longer in the elderly group and even longer for patients with complications (p < 0.001). There was no mortality. Cardiac disease was the only independent predictor of peri-operative complications (OR = 4.2).


CONCLUSIONS
Severe forms of acute appendicitis and post-operative morbidity are higher in the elderly population. Cardiac disease is the only predictor for increased morbidity. Although CT scan was performed universally in the elderly group, it did not appear to increase time from presentation to surgery.
General Surgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel. caoded@hadassah.org.il.
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Cohen-Arazi
General Surgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel.
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Dabour
General Surgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel.
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M
Bala
General Surgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel.
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Haran
General Surgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel.
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Almogy
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Acute appendicitis; Cardiac disease; Elderly