Nonoperative Management of Acute Appendicitis in the Geriatric Population: A Review

Appendicitis remains a common cause of acute abdominal pain, particularly challenging to manage in elderly patients due to age-related declines in physiological reserve and the presence of comorbidities. While appendectomy has traditionally been the standard treatment, nonoperative management (NOM) using antibiotics has emerged as a potential alternative for elderly patients, especially those considered frail or at high surgical risk. This review explores the efficacy and outcomes of NOM compared to surgery in this population, with a focus on recurrence rates, postoperative complications, and the impact of frailty on treatment decisions. Recent studies highlight both the benefits and limitations of NOM. While it can effectively manage uncomplicated appendicitis in the short term, recurrence rates are significantly higher in elderly patients, often necessitating delayed surgery, which can lead to worse outcomes. Research also shows that frail patients face elevated risks of complications, including mortality, whether treated surgically or nonoperatively. The review underscores the importance of careful patient selection, close monitoring, and individualized treatment approaches when considering NOM for elderly patients with appendicitis. Long-term risks such as recurrence, antibiotic resistance, and complications further complicate the decision-making process.