Management and outcome of appendicitis among octogenarians in an English hospital over a five year period

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.

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.

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%).

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.