Appendicitis in the elderly

Background: Acute appendicitis in the elderly (i.e. those over 60 years of age) is associated with high morbidity and mortality rates. The present ret rospective study reviews 10 years (1986-1996) of experience and outcome in treating acute appendicitis in patients aged 60 or above. Methods: One hundred and thirty patients with acute appendicitis were ident ified and their case notes reviewed. Results: Acute appendicitis was diagnosed at admission in 84 patients (64.6 %). The remaining patients were observed for a median duration of 9.4 h pri or to diagnosis and treatment. Patients with an underlying perforated acute appendix had a significantly longer period of pain prior to admission (P = 0.029; Mann-Whitney (U-test) but perforation per se was not associated wit h a significantly higher rate of morbidity and longer length of hospital st ay. In contrast, the use of midline or paramedian incisions was associated with a higher wound infection rate (P=0.003: Pearson chi-squared test) and a longer hospital stay (P<0.001; Mann-Whitney U-test). None of the patients were subsequently found to have an underlying colonic neoplasm. The overal l morbidity rate was 28%. The mortality rate was 2.3% and all three patient s who died had a severe comorbid medical condition prior to developing acut e appendicitis. Conclusions: Acute appendicitis in the elderly is still associated with sig nificant morbidity. But once acute appendicitis is diagnosed, then expedien t surgery, appropriate use of perioperative antibiotics and a right lower q uadrant incision can help to minimize the morbidity. Pre-existing severe co morbid medical condition(s) is a major contributory factor to mortality in these patients.