Acute Appendicitis in Elderly: Diagnosis and Management Still a Challenge

Jasneet S Bhullar, MD, MS, Sushant Chaudhary, MD, MS, Jennifer Gayagoy, MD, Jacob Adams, BS, Jenna Watson, BS, Peter Lopez, MD, Vijay K Mittal, MD, FACS

Department of Surgery, Providence Hospital

Background: Acute appendicitis is a common surgical emergency affecting all age groups. Early diagnosis with appropriate management improves outcomes. With an aging population, focus has shifted on better care and outcomes in the elderly.

Methods: A retrospective chart review of 790 patients treated for appendicitis at a community urban hospital from Aug 2008 to Aug 2011 was done. Demographic features, preoperative clinical diagnosis, diagnostic workup, Alvarado score, operative interventions and postoperative morbidity were analyzed.

Results: Of the 790 patients, 51% were male and 49% female. While 14% of patients were >60, 75% were between15-60 years of age . Mean BMI was 27±7 kg/m2. The WBC count of most patients (56%) was between 10800-20,000, while in 26% it was below 10,000. Diagnosis was made on clinical evaluation alone (3%), radiological basis alone (8%) or combination of both (73%). 49% of patients had an Alvarado score of 6-8 and 30% had a score of 3-5. Majority (78%) underwent laparoscopic appendectomy. Overall morbidity was 8% with 1 mortality. Mean length of stay in <16 (1.5±1.0) and 16-60 years-old age groups (2.0±2.3) was significantly increased in 60-85 (4.5±4.5 days) and >85 years-old age groups (6.2±3.6). Increasing age (>60 vs. <60 years old) was associated with increased morbidity (14% vs. 7%, respectively, p<0.0001), but notwith gender or BMI (p<0.069).

Conclusions: Patients over the age of 60 with acute appendicitis had an increased morbidity and length of stay as compared to younger patients. A high degree of suspicion to expedite diagnosis and management in elderly may improve outcomes.

Session: Poster Presentation

Program Number: P594

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