THE INFLUENCE OF AGE ON THE SEVERITY OF PERITONITIS

OBJECTIVE: To evaluate the influence of age on the evolution and sever ity of peritonitis. DESIGN: A chart review. SETTING: An adult universi ty hospital. PATIENTS: One hundred and twenty-two patients with acute appendicitis and 100 patients with acute colonic diverticulitis requir ing operation or percutaneous drainage. MAIN OUTCOME MEASURES: Patient age and sex, presence of perforation or gangrene (appendicitis, exten t of peritonitis (diverticulitis); duration of symptoms prior to admis sion; admission leukocyte count; duration of hospitalization before su rgery; length of hospital stay; and death rate. RESULTS: Patients with acute appendicitis who were aged 65 years or older were three times m ore likely than younger patients to have a gangrenous or perforated ap pendix (odds ratio 3.1, 95% confidence interval 1.1 to 8.4, p < 0.05); older patients with perforated diverticulitis were three times more l ikely than younger patients to have generalized peritonitis than local ized (pericolic or pelvic) peritonitis (odds ratio 2.9, 95% confidence interval 1.2 to 7.5, p < 0.05). CONCLUSION: These findings are consis tent with the hypothesis that the biologic features of peritonitis dif fer in the elderly, who are more likely to present with an advanced or severe process than young patients.