Age-related clinical features in older patients with acute appendicitis

Acute appendicitis, the most common cause of abdominal surgical emergency, shows a different pathogenesis, clinical course and outcome in the elderly. Age-specific factors are effective on preoperative clinical diagnosis and on the stage of this infectious disease. We aimed to present our experience with a series of elderly patients with appendicitis who were subjected to appendectomy. Operative and hospital records of patients with appendicitis were retrospectively reviewed. Patients who were 50 years of age or older were the main constituents of the study. Demographic features, preoperative clinical diagnosis, abdominal interventions, and postoperative morbidity and mortality were analysed as the main criteria. A total of 109 older patients have constituted 4.3% of our appendectomy cases. Besides right lower quadrant transversal incisions, surgery was performed via vertical incisions in 28.4% of cases with a diagnosis of acute abdomen. In the elderly, the perforation rate was significantly higher than in paediatric and adult patients (P<0.001). The proportion of the elderly among perforated cases was significantly increased when compared with non-perforated cases (12.9 versus 2.9%; P<0.001). Postoperative morbidity was noted in 35.8% of elderly patients, in 73.8% of perforated, and in 11.9% of non-perforated cases (P<0.001). The mortality rate was 5.5% in the elderly group, 11.9% in patients with perforated, and 1.5% in patients with non-perforated appendicitis. No mortality was noted in patients younger than 50 years. The precise diagnosis of appendicitis is relatively low in the elderly. Despite the uncommon occurrence of appendicitis, the perforation rate is still unfavourable. Postoperative morbidity and mortality is unacceptably high. Advancing age adversely affects clinical diagnosis, the stage of disease and the outcome of patients. Perforated appendicitis and septic progression is the main cause of undesirable outcomes.