Does age matter? acute appendicitis in octogenarians vs. younger patients - results of a German multicenter analysis

Background Acute appendicitis is a common indication for emergency abdominal surgery. Octogenarians (≥ 80 years) are considered high risk due to comorbidities and reduced physiological reserve. This study examined age-related differences in symptoms, surgical management, and outcomes in patients undergoing surgery for acute appendicitis. Methods This multicenter retrospective cohort study includes 1,582 surgically treated patients from 41 German hospitals, comprising 1,533 non-octogenarians (18–79 years) and 49 octogenarians (≥ 80 years). Results Octogenarians had higher comorbidity burden and ASA classification (both p < 0.001). Clinical presentation was largely comparable; however, octogenarians experienced lower pain intensity (p = 0.05) and had higher CRP levels (p < 0.001). Complicated appendicitis was more prevalent in octogenarians (63.3% vs. 28.1%; p < 0.001), with higher rates of perforation, peritonitis, and abscess formation (all p < 0.001). Consequently, extended resections (p = 0.01), open or converted surgery (p < 0.001), drainage (p < 0.001), and stoma formation (p = 0.01) were more common. Postoperative complications (p < 0.001), mortality (p = 0.002), ICU admission (p < 0.001), duration of antimicrobial therapy (p < 0.001), and hospital stay (p < 0.001) were all increased. Following propensity score matching, outcomes were largely comparable between octogenarians and younger patients, indicating the comorbidity spectrum of the elderly, rather than chronological age alone, as key determinants. Conclusion Despite a similar initial presentation, octogenarians present with more advanced appendicitis and significantly worse postoperative outcomes. This emphasizes the need for age- and comorbidity-adapted diagnostic and perioperative strategies.