Acute appendicitis in the elderly patient: diagnostic problems, prognostic factors and outcomes

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.

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

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).

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.