Practice patterns and clinical outcomes in acute appendicitis differ in the elderly patient

Area of Science:

• Surgical emergency management
• Geriatric medicine
• Clinical outcomes research

Background:

• Appendicitis remains a leading cause of emergency abdominal surgery globally.
• An aging population presents unique challenges in diagnosing and treating appendicitis due to atypical symptoms and delayed presentations.

Purpose of the Study:

• To compare the presentation, management, and outcomes of acute appendicitis between elderly patients (≥65 years) and younger adults (18-64 years).
• To identify disparities that may inform age-specific diagnostic and treatment protocols.

Main Methods:

• Subgroup analysis from the ESTES SnapAppy prospective, observational cohort study.
• Inclusion of patients aged 15 years and above undergoing laparoscopic appendectomy over a 90-day period.
• Statistical comparisons using appropriate tests with a significance level of p < 0.05.

Main Results:

• Elderly patients showed delayed presentation (7.88 vs. 3.56 days) and higher CT scan utilization (86.1% vs. 54.0%).
• Complicated appendicitis was more frequent in the elderly (46.7% vs. 20.7%), with higher rates of postoperative complications (27.9% vs. 12.9%) and prolonged hospital stays (7.9 vs. 3.6 days).
• Elderly patients experienced longer operative times (71.1 vs. 60.3 min) and a higher incidence of severe complications (6.9% vs. 2.4%).

Conclusions:

• Significant differences exist in the clinical course and outcomes of acute appendicitis between elderly and younger patients.
• Findings underscore the need for age-adapted diagnostic pathways and treatment strategies to enhance outcomes in the elderly population.
• This research highlights a critical area for improving care for a vulnerable demographic experiencing a common surgical emergency.