The risks of failed nonoperative management of appendicitis in older adults

Abstract

BackgroundThe consequences of failed nonoperative management of appendicitis in older patients have not been described. MethodsWe 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. ResultsFor 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. ConclusionsNonoperative management of appendicitis should be approached cautiously for older adults.