Key result
Having ≥2 preoperative comorbidities is linked to surgical complications and ICU admission in older appendicitis patients.
Why the study?
Patients older than 50 years with acute appendicitis have higher mortality, perforation, and complication rates, but clinical, laboratory, and imaging factors affecting their operative and postoperative outcomes require evaluation.
Observational (n=152)
No
p-value: p=0.002
In patients over 50 undergoing emergent appendectomy, preoperative comorbidities and lower albumin levels are associated with higher surgical complications and longer hospital stays.
May inform preoperative risk stratification by comorbidity count in older appendicitis patients; hypothesis-generating for interventional trials.
BACKGROUND: Studies reported higher mortality and perforation rates, marked increase in delay from symptom onset to hospital admission, significant complication rates, as well as excessive malignancy outcomes on histopathological examinations in patients older than 50 years of age with acute appendicitis. Herein, it was aimed to reveal the clinical, laboratory, and imaging findings that might affect the operative and post-operative findings in a population of patients over the age of 50 who were diagnosed with and operated for acute appendicitis. METHODS: Patients who were older than 50 years of age and operated for the diagnosis acute appendicitis between January 2017 and January 2020 in a single tertiary hospital were included in this retrospective study. Demographic data, comorbidities, laboratory and imaging findings, operative and post-operative results, surgical complications, as well as the histopathological evaluation of the excised materials of all patients were analyzed in detail. RESULTS: A total of 152 patients who were older than 50 years of age and who underwent emergent appendectomy with a median age of 59 were included in the study. It was demonstrated that the development of surgical complications was significantly associated with post-operative hospitalization at the intensive care unit (ICU) and the presence of 2 or more comorbidities preoperatively (p=0.006 and p=0.002, respectively). It was observed that the duration of total hospitalization was longer (p<0.001), pre-operative al-bumin levels were lower (p=0.017), and the rate of hospitalization at ICU during the follow-up period was higher (p=0.006) in patients with surgical complications. Pre-operative white blood cell counts appeared to be significantly increases in patients who had open appendectomy (p=0.047). Moreover, both the duration of pre-operative abdominal pain and pre-operative C-reactive protein levels was found to significantly correlate with the duration of hospitalization (p<0.001 and p<0.001, respectively). CONCLUSION: The management of acute appendicitis in late adulthood was suggested to be challenging both in terms of diagnosis and post-operative processes. Therefore, pre-operative clinical, laboratory, and imaging data obtained from these patients should be carefully and elaborately evaluated.
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Oğuz Hançerlioğulları (2022) conducted an observational in Acute appendicitis (n=152). Preoperative clinical variables and comorbidities was evaluated on Surgical complications (p=0.002). In patients over 50 with acute appendicitis, surgical complications were significantly associated with having ≥2 preoperative comorbidities (p=0.002) and ICU admission (p=0.006).
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