Appendicitis In Elderly Patients Research Articles

Evaluation of the results of laparoscopic surgical treatment for acute appendicitis in elderly patients

Objectives: The aim of this study was to evaluate the clinical and paraclinical characteristics and results of treatment of acute appendicitis in elderly patients. Methods: A prospective study was conducted on 189 patients, including 42 of them over the age of 60, diagnosed with acute appendicitis or peritonitis due to appendicitis based on clinical and paraclinical symptoms and treated with laparoscopic surgery from April 2022 to June 2023 at the Department of Digestive Surgery, Hue University of Medicine and Pharmacy Hospital. Results: Elderly patients with acute appendicitis admitted to the hospital had an average age of 69.3 years. The time from symptom onset to hospital admission in elderly patients was 30.1 hours compared to 19.1 hours in the non-elderly group. The elderly group had a rate of peritonitis of 40,5% compared to 13.6% in the non-elderly group (p < 0.001). The mean time for passing initial gas in elderly patients was 18,1 hours compared to 13.3 hours in the non-elderly group (p = 0.004). Postoperative hospital stay in elderly patients was 4.7 days compared to 3.5 days in the non-elderly group (p < 0.001). Postoperative complications in the elderly patient group were 2.4% compared to 0% in the non-elderly group (p = 0.222). There were no complications during surgery or 30-day mortality. Conclusions: Elderly patients with acute appendicitis were hospitalized later, had a higher rate of peritonitis and had a longer postoperative hospital stay than non-elderly patients. Laparoscopic surgery to treat acute appendicitis in the elderly is a safe method. Key words: acute appendicitis, elderly, laparoscopic appendectomy, appendicitis peritonitis.

Clinical effectiveness study of the new diagnostic score of acute appendicitis in the elderly

Introduction. Acute appendicitis is among the three most frequent surgical diseases. The lifetime likelihood of developing acute appendicitis is around 7%. The incidence of acute appendicitis reduces with age after adolescence. Several studies evaluated the relevance of the current scores to the general population, mostly children, but a limited number of studies have studied the elderly population. This study aims to assess the clinical effectiveness of the new diagnostic score for the elderly population in comparison to both the Alvarado score and the non-standardized score. Material and methods. In order to evaluate the effectiveness of the diagnostic score of acute appendicitis, we examined 78 patients who were admitted to emergency unit of the Saint Archangel Michael Municipal Clinical Hospital during 20182021 with the presumptive diagnosis of acute appendicitis. Of all patients admitted, Acute Appendicitis was confirmed on pathological examination in 22 (28.2%) patients. The average age of patients was 73.5±13.5 years (minimum - 60 years, maximum - 87 years). The ratio of males to females was 1:1.6. Results. Comparative evaluation of the new diagnostic score of acute appendicitis and the non-standardized clinical-echographic examination for acute appendicitis diagnosis showed better performance indicators of the new diagnostic score of acute appendicitis compared to the non-standardized clinical method for acute appendicitis diagnosis. The high sensitivity of the new diagnostic score of acute appendicitis was statistically demonstrated (ƛ2 = 4.32; p < 0.05), a lower rate of missed acute appendicitis cases in the new diagnostic score of acute appendicitis (ƛ2 = 4.32; p < 0.05), the „grey area” is lower in the new diagnostic score of acute appendicitis (ƛ2 = 5.28; p < 0.05), than in the non-standardized diagnosis. It was shown to have a lower rate of acute appendicitis cases in the „grey area” of the total number of acute appendicitis cases (ƛ2 = 4.9; p < 0.05). Benchmarking indicators such as specificity and diagnostic accuracy showed no statistically significant differences. At the same time, a definite increase in specificity and accuracy was observed for the new diagnostic score of acute appendicitis compared to non-standardized clinical diagnosis. Conclusions. Diagnosing acute appendicitis in elderly patients remains challenging due to the numerous potential diagnoses with similar clinical manifestations that are observed in this patient population. It was necessary to utilize clinical risk-scoring systems that could aid in the prompt identification of patients with acute appendicitis. This study concludes that the New diagnostic score has higher clinical efficiency in diagnosing acute appendicitis in elderly patients. It has a sensitivity of up to 93.15%, compared to the unstandardized clinical method and the Alvarado diagnostic score, and is independent of „risk factors” such as obesity and atypical vermiform appendix localization.

An extremely rare clinical manifestation of acute appendicitis in a nonagenarian patient: lessons still to be learned.

Abstract.

Factors associated with postoperative complications following appendectomy in elderly patients.

Appendicitis in elderly patients is more challenging due to delayed presentation and higher comorbidities, which are associated with increased postoperative morbidity. The aim of this study was to evaluate factors that predict 30-day complications in elderly patients undergoing appendectomy. The records of elderly patients who underwent appendectomy were reviewed. The primary outcome was 30-day postoperative complications. Independent variables examined included demographic data, comorbidities, preoperative laboratory values, pathological findings, and surgical features. Both univariate and multivariate regression analyses were performed to identify factors associated with postoperative complications. Evaluation was performed on 80 patients, comprising 63.8% females with a mean age of 71.3 years. Notably, 19 (23.8%) patients had one or more complications within 30 days after surgery. No significant difference was found between patients with and without complications in respect of age, gender, or laboratory features. The rates of American Society of Anesthesiologists scores 3-4 (p=0.006), hypertension (p=0.016), cardiovascular disease (p=0.049), and obesity (p=0.040) were significantly higher for patients with complications than for those without. On multivariate analysis, obesity (OR 9.41), chronic obstructive pulmonary disease (OR 9.72), and open appendectomy (OR 14.87) were independently associated with 30-day postoperative complications. Older patients undergoing appendectomy tend to have poorer outcomes than younger patients. Therefore, it is critical to identify factors that could reduce the possibility of adverse outcomes in this frail population. The results of this study suggest that obesity, chronic obstructive pulmonary disease, and an open approach are independent factors for complications in elderly patients undergoing appendectomy.

EAES rapid guideline: appendicitis in the elderly.

There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients. We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus. This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 . This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.

A Diagnostic Score (DS) Is a Powerful Tool in Diagnosis of Acute Appendicitis in Elderly Patients With Acute Abdominal Pain.

Although acute appendicitis (AA) in elderly patients is different from AA in younger patients, the accuracy of diagnostic scores (DSs) in detecting AA is rarely considered. A cohort of 470 AAP (acute abdominal pain) patients older than 50 years, including 224 women (53.7%) and 193 men (46.3%), were included in the study. The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis with (Tax+) and without body temperature (Tax-). Meta-analytical techniques were used to calculate the summary Se and Sp estimates for each data sets (history-taking, findings, and DS formulas). In SROC analysis, the AUC values for i) symptoms ii) signs and tests iii) DSTax- and iv) DSTax+ were as follows: i) AUC=0.658 (95%CI=0.601-0.709); ii) AUC=0.751 (95%CI=0.701-0.800), iii) AUC=0.977 (95%CI=0.942-1.000), and for iv) AUC=0.980 (95%CI=0.956-1.000). Using roccomp analysis for these AUC values, the differences were significant as follows: between i) and ii) p=0.0358; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.682. Similar to younger AA patients, the DS formula was superior to both the clinical history-taking and findings, and therefore, the use of DS should be an important part of the diagnostic decision tree of AA also in the elderly patients presenting with AAP.

The effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis Score in the diagnosis of acute appendicitis in elderly patients

Acute appendicitis (AA) is the most common cause of acute abdominal surgeries, accounting for 15% of all emergency visits due to acute abdominal pain in patients aged over 60 years. Appendicitis is reported as the third most common cause of abdominal surgery in geriatric patients. In this current retrospective study, the records of 68 patients aged over 65 years, who were treated by surgical resection in our clinic diagnosed for AA between February 2015 and February 2020, were analyzed. The age, gender, duration of hospital stay of the patients and, histopathological results of appendectomy specimens were recorded. The Raja Isteri Pengrian Anak Saleha Appendicitis (RIPASA) Score of the patients was calculated according to the clinical history, physical examination, and laboratory parameters of the patients. According to the RIPASA scores, the patients were divided into three groups as the low-score group (4 to 7), the intermediate-score group (7.5 to 11.5), and the high-score group (≥ 12). The groups were compared on the basis of the microscopic diagnosis. According to the calculated RIPASA score, there were 12 patients in the low-score group, 44 patients in the intermediate-score group, and 12 patients in the high-score group. When the results were classified based on the pathology, we detected non-complicated conditions such as a normal appendix or reactive lymphoid hyperplasia in ten patients and catarrhal stage appendicitis in 38 patients along with complicated (gangrenous or perforated) appendicitis in 20 patients. In conclusion, the RIPASA score can be used in elderly patients considering its high accuracy rate. In elderly patients with a high RIPASA score, the pathological stage of the appendectomy specimen may also be complicated (perforated or gangrenous) appendicitis. Therefore, the mortality and morbidity rates may increase with increased complication rates.

Unexpected complicated appendicitis in the elderly diagnosed with acute appendicitis

BackgroundThis study determined the prevalence of complicated appendicitis in elderly patients diagnosed preoperatively with uncomplicated appendicitis. MethodsPatients with a preoperative diagnosis of uncomplicated appendicitis at an academic hospital from 11/2013 to 05/2017 were reviewed. Patients ≥65 years were compared to those younger. Pathology reports were categorized as either uncomplicated or complicated (COMP). The primary outcome was the prevalence of COMP appendicitis. ResultsThe prevalence of COMP appendicitis increased with age after 20 years with an abrupt increase after 65 years. Patients ≥65 years were more likely to have COMP appendicitis (48.1% vs. 15.5%; OR: 5.1; p < 0.01) and prolonged stays (3.8 vs. 2.3 days; p < 0.01). ConclusionNearly half of elderly patients had pathologic confirmation of complicated appendicitis despite no preoperative clinical or radiographic suspicion for complicated appendicitis. Nonoperative management of acute appendicitis in the elderly may not be appropriate due to the high rate of unexpected complicated appendicitis.

Use of the Alvarado Score in Elderly Patients with Complicated and Uncomplicated Appendicitis

The purpose of this study was to determine whether the Alvarado score is beneficial in identifying complicated versus uncomplicated acute appendicitis in elderly patients. A retrospective review was conducted of patients aged 65 years and older who underwent an appendectomy for pathologically confirmed appendicitis. A review of 310 operative reports and patient charts from October 2012 to December 2016 yielded 216 patients. Patients were grouped based on complicated versus uncomplicated appendicitis. One hundred ten patients had complicated appendicitis, whereas 106 patients were uncomplicated. Among the complicated appendicitis patients, 76.4 per cent were perforated, 38.2 per cent were gangrenous, and 34.5 per cent had an abscess. The complicated appendicitis group had a higher mean duration of symptoms (2.70 ± 3.41 days vs 2.09 ± 3.08 days, P = 0.011). Appendectomies that were open or converted to open were more likely to be associated with complicated appendicitis (75% vs 48%, P = 0.012). Mean hospital length of stay was greater in those with complicated appendicitis (5.34 ± 5.56 days vs 3.12 ± 2.86 days, P < 0.001). The two groups did not differ on mean Alvarado score (complicated = 6.96 ± 1.99 vs uncomplicated = 6.72 ± 1.85, P = 0.36). Only 62.5 per cent of patients had an Alvarado score that met the cutoff for acute appendicitis. The Alvarado score was not able to differentiate complicated from uncomplicated appendicitis in elderly patients.

The Alvarado score and computed tomography for predicting acute appendicitis in elderly patients

The Alvarado score and computed tomography for predicting acute appendicitis in elderly patients

Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department.

The diagnostic value of the neutrophil-to-lymphocyte count ratio (NLR) and the Appendicitis Inflammatory Response (AIR) score for identifying acute appendicitis (AA) perforation in elderly patients in the emergency department (ED) were evaluated. A total of 103 patients who were admitted for appendectomy for AA via the ED between January 2012 and December 2014 were reviewed retrospectively. Patients aged 65 and over were included. Patient age, sex, comorbidities, body temperature, clinical findings and initial laboratory results including white blood cell (WBC) count, NLR, serum levels of CRP and total bilirubin (TB) in the ED were assessed, and the AIR score was calculated. Perforation due to AA was identified in 58 (56.3%) elderly patients. Median WBC count, neutrophil count, CRP and TB were significantly higher in the perforated group compared to the non-perforated group (p=0.005, p=0.001, p=0.004 and p=0.012) in the ED. The NLR was significantly different in the two groups (perforated vs non-perforated group, 9.5 vs 5.1, p<0.001). The area under the curve value of NLR was 0.755 (95% CI 0.660-0.834), and the cutoff value was 5.6 (sensitivity 78.0% and specificity 65.9%). In multivariate logistic analysis, NLR>5.6 [odds ratio (OR) 6.794, p=0.001] was significant independent factor for AA perforation in elderly patients. The AIR score risk probability did not differ between the two groups of elderly patients (p=0.094). Twenty-five (42.4%) patients in the perforated group and five (11.4%) patients in the non-perforated group were classified as high probability by the modified AIR score including the NLR value (p=0.001). We suggest that the initial NLR in the elderly patient is the most powerful predictive factor for the diagnosis of AA perforation in the ED.

Acute Appendicitis in the Elderly in the Twenty-First Century

BackgroundThe incidence of appendicitis in the elderly has risen. Older age is an independent predictor of poor surgical outcome. Herein, we present the most comprehensive single institution study to describe the natural history and outcome of appendicitis in elderly patients. MethodsA review of 1898 consecutive patients who underwent appendectomy between 2004 and 2007 was performed. The elderly patients were defined as older than 68 years. ResultsThe median age of the entire cohort was 25 years, and 55 % were males. The elderly group included 68 patients (3.6 %). On comparison by age, the elderly group had a significantly longer delay from symptom onset to admission (50 vs 31 h, P = 0.01) and from admission to surgery, a longer operative time and hospital stay, and higher rates of postoperative complications and complicated appendicitis. ConclusionThe current study demonstrated several unique characteristics of the elderly population with acute appendicitis, which include poor outcome and longer time intervals to diagnosis and treatment. In order to improve the poor outcome of the elderly population with appendicitis, prospective trials are necessary.

Factors Associated with Perforated Appendicitis in Elderly Patients in a Tertiary Care Hospital.

Background. The incidence of perforated appendicitis in elderly patients is high and carries increased morbidity and mortality rates. The aim of this study was to identify risk factors of perforation in elderly patients who presented with clinical of acute appendicitis. Methods. This was a retrospective study, reviewing medical records of patients over the age of 60 years who had a confirmed diagnosis of acute appendicitis. Patients were classified into two groups: those with perforated appendicitis and those with nonperforated appendicitis. Demographic data, clinical presentations, and laboratory analysis were compared. Results. Of the 206 acute appendicitis patients over the age of 60 years, perforated appendicitis was found in 106 (50%) patients. The four factors which predicted appendiceal rupture were as follows: male; duration of pain in preadmission period; fever (>38°C); and anorexia. The overall complication rate was 34% in the perforation group and 12.6% in the nonperforation group. Conclusions. The incidence of perforated appendicitis in elderly patients was higher in males and those who had certain clinical features such as fever and anorexia. Duration of pain in the preadmission period was also an important factor in appendiceal rupture. Early diagnosis may decrease the incidence of perforated appendicitis in elderly patients.

Acute appendicitis in the elderly: risk factors for perforation

BackgroundAcute appendicitis is the most common surgical emergency and becomes serious when it perforates. Perforation is more frequent in the elderly patients. The aim of this study was to identify the risk factors of perforation in elderly patients who presented with acute appendicitis.MethodologyThe medical records of 214 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis over a period of 10 years (2003-2013) were retrospectively reviewed. Patients were grouped into those with perforated and those with nonperforated appendicitis. Comparison was made between both groups in regard to demography, clinical presentation, and time delay to surgery, diagnosis, hospital stay and postoperative complications. Clinical assessment, Ultrasonography and Computerized tomography, in that order, were used for diagnosis. The incidence of perforation was also compared with a previous report from the same region 10 years earlier.ResultsDuring the study period, a total of 214 patients over the age of 60 years had acute appendicitis, 103 males and 111 females. Appendix was found perforated in 87 (41%) patients, 46 (53%) males and 41 (47%) females. Of all patients, 31% were diagnosed by clinical assessment alone, 40% needed US and 29% CT scan. Of all the risk factors studied, the patient’s pre-hospital time delay was the most important risk factor for perforation. Perforation rate was not dependent on the presence of comorbid diseases or in-hospital time delay. Post operative complications occurred in 44 (21%) patients and they were three times more common in the perforated group, 33 (75%) patients in the perforated and 11 (25%) in the nonperforated group. There were 6 deaths (3%), 4 in the perforated and 2 in the nonperforated group.ConclusionAcute appendicitis in elderly patients is a serious disease that requires early diagnosis and treatment. Appendiceal Perforation increases both mortality and morbidity. All elderly patients presented to the hospital with abdominal pain should be admitted and investigated. The early use of CT scan can cut short the way to the appropriate treatment.

Outcomes of acute appendicitis in elderly patients: a 5-year experience at a single institution

Outcomes of acute appendicitis in elderly patients: a 5-year experience at a single institution

Outcomes of acute appendicitis in elderly patients: a 5-year experience at a single institution

Amac. Genc ve yasli hastalarda elektif cerrahi islemlerin sonuclari benzer gorulse de, yaslilarda acil cerrahiler onemli morbidite ve mortaliteye yol acabilir. Bu calisma yasli hasta grubunda akut apandisit yonetimindeki tecrubemizi sunmak amaciyla yapildi. Corresponding author: Dr. Ali Kagan Gokakin, Genel Cerrahi Anabilim Dali, Cumhuriyet Universitesi Tip Fakultesi, 58140 Sivas. Email: dralihan20@hotmail.comYontem. 2007-2012 yillari arasinda akut apandisit nedeniyle apandektomi yapilan hastalar calismaya alindi. Diger akut batin nedenleri saptanan olgular calisma disi tutuldu. Bu kosullara gore 1382 olgu calisma kapsaminda degerlendirildi. Calismaya alinan olgular uc yas grubuna bolundu: grup I, yas<29; grup II, yas 29-65; ve grup III, 65 yas ve uzeri. Yas, cinsiyet, belirtilerin suresi, hastanede yatis suresi (toplam ve preoperatif), ameliyat tipi, bulgulari ve ameliyat suresi, morbitite ve mortalite oranlari ve patolojik bulgularin uyumlulugu verileri degerlendirildi. Bulgular. Belirtilerin suresi ve hastanede yatis suresi (toplam ve preoperatif) grup III’de daha fazla bulundu. Postoperatif sonuclar grup III olgularda diger gruplara gore daha kotu bulundu; ama yanlis tani orani diger gruplara gore daha dusuktu. Sonuclar. Yaslilarda akut apandisit cerrahi pratiginin zor kisimlarindan biridir ve daha yuksek morbidite ile birliktedir. Yasam suresinin artmasi ile birlikte gelecekte bu olgularla daha fazla karsilasilacagi beklenilmelidir.

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution

Outcomes of acute appendicitis in elderly patients: 5 years’ experience of a single institution