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Published on: July 26, 2024
The risks of failed nonoperative management of appendicitis in older adults
Nicole Lunardi1, Elisa Marten2, Sherene Sharath3
1Department of Surgery, University of Texas Southwestern, Dallas, TX, USA; Department of Surgery, North Texas VA Health Care System, Dallas, TX, USA.
Background:
The consequences of failed nonoperative management of appendicitis in older patients have not been described.
Methods:
We used the 2004-2017 National Inpatient Sample to identify acute appendicitis patients managed nonoperatively (<65 years old: 32,469; ≥65 years old: 11,265). Outcomes included morbidity, length of stay (LOS), inpatient costs, and discharge to skilled facilities. Differences were estimated using propensity scores.
Results:
For patients <65, nonoperative failure was associated with increased morbidity (7 % [95 % CI 6.9 %-8.1 %]), LOS (3 day [95 % CI 3-4]), costs ($9015 [95 % CI $8216- $9446]), and discharges to skilled facilities (1 % [95 % CI 0.9 %-1.6 %]) compared to successful nonoperative treatment. Patients ≥65 had differences in morbidity (14 % [95 % CI 13.6 %-16.2 %]), LOS (6 days [95 % CI 5-6]), costs ($15,964 [95 % CI $15,181- $17,708]), and discharges to skilled facilities (12 % [95 % CI: 10.0 %-13.3]) compared to nonoperative success.
Conclusions:
Nonoperative management of appendicitis should be approached cautiously for older adults.
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