Unexpected complicated appendicitis in the elderly diagnosed with acute appendicitis

Area of Science:

• Gastroenterology
• Geriatric Medicine
• Surgical Pathology

Background:

• Appendicitis is common, but its presentation and outcomes differ in elderly patients.
• Preoperative diagnosis of uncomplicated appendicitis in the elderly may underestimate disease severity.

Purpose of the Study:

• To determine the prevalence of complicated appendicitis (COMP) in elderly patients (≥65 years) initially diagnosed with uncomplicated appendicitis.
• To compare the incidence of COMP appendicitis and associated outcomes between elderly and younger patient groups.

Main Methods:

• Retrospective review of patients with preoperative uncomplicated appendicitis diagnosis.
• Comparison of patients aged ≥65 years with younger patients.
• Categorization of appendicitis as uncomplicated or complicated (COMP) based on pathology reports.

Main Results:

• COMP appendicitis prevalence increases with age, with a significant rise after 65 years.
• Elderly patients had a higher likelihood of COMP appendicitis (48.1% vs. 15.5%) and longer hospital stays.
• Age ≥65 years was associated with a 5.1-fold increased odds of COMP appendicitis.

Conclusions:

• Nearly half of elderly patients with a preoperative diagnosis of uncomplicated appendicitis were found to have COMP appendicitis pathologically.
• The high rate of unexpected COMP appendicitis in the elderly suggests nonoperative management may be inappropriate.
• Further research is needed to optimize appendicitis management strategies for geriatric populations.