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Fransvea P, Chiarello MM, Fico V, Cariati M, Brisinda G. Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis. World J Clin Cases 2024; 12:6580-6586. [DOI: 10.12998/wjcc.v12.i33.6580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 09/27/2024] Open
Abstract
In developed countries, the average life expectancy has been increasing and is now well over 80 years. Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups. Acute appendicitis is one of the most common surgical diseases, with a lifetime risk of 8%. A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups (> 80 years). Among patients > 50-year-old who present to the emergency department for acute abdominal pain, 15% have acute appendicitis. In these patients, emergency surgery for acute appendicitis is challenging, and some important aspects must be considered. In the elderly, surgical treatment outcomes are influenced by sarcopenia. Sarcopenia must be considered a precursor of frailty, a risk factor for physical function decline. Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity. Aside from morbidity and mortality, the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance. Therefore, prediction of function decline is critical. In emergency surgery, preoperative interventions are difficult to implement because of the narrow time window before surgery. In this editorial, we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.
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Affiliation(s)
- Pietro Fransvea
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | | | - Valeria Fico
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | - Maria Cariati
- Department of Surgery, Provincial Health Authority, Crotone 88900, Italy
| | - Giuseppe Brisinda
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
- Translational Medicine and Surgery, Catholic School of Medicine, Roma 00168, Italy
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Cimino MM, Biloslavo A, Kurihara H, Bellio G, Porta M, Fattori S, Bass GA. Practice patterns and clinical outcomes in acute appendicitis differ in the elderly patient. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02620-w. [PMID: 39126520 DOI: 10.1007/s00068-024-02620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Appendicitis is the most frequent global abdominal surgical emergency. An ageing population, who often exhibit atypical symptoms and delayed presentations, challenge conventional diagnostic and treatment paradigms. OBJECTIVES This study aims to delineate disparities in presentation, management, and outcomes between elderly patients and younger adults suffering from acute appendicitis. METHODS This subgroup analysis forms part of ESTES SnapAppy, a time-bound multi-center prospective, observational cohort study. It includes patients aged 15 years and above who underwent laparoscopic appendectomy during a defined 90-day observational period across multiple centers. Statistical comparisons were performed using appropriate tests with significance set at p < 0.05. RESULTS The study cohort comprised 521 elderly patients (≥65 years) and 4,092 younger adults (18-64 years). Elderly patients presented later (mean duration of symptoms: 7.88 vs. 3.56 days; p < 0.001) and frequently required computed tomography (CT) scans for diagnosis (86.1% vs. 54.0%; p < 0.001). The incidence of complicated appendicitis was higher in the elderly (46.7% vs. 20.7%; p < 0.001). Delays in surgical intervention were notable in the elderly (85.0% operated within 24 h vs. 88.7%; p = 0.018), with longer operative times (71.1 vs. 60.3 min; p < 0.001). Postoperative complications were significantly higher in the elderly (27.9% vs. 12.9%; p < 0.001), including severe complications (6.9% vs. 2.4%; p < 0.001) and prolonged hospital stays (7.9 vs. 3.6 days; p < 0.001). CONCLUSIONS Our findings highlight significant differences in the clinical course and outcomes of acute appendicitis in the elderly compared to younger patients, suggesting a need for age-adapted diagnostic pathways and treatment strategies to improve outcomes in this vulnerable population.
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Affiliation(s)
- Matteo Maria Cimino
- Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Alan Biloslavo
- General Surgery Department, Cattinara University Hospital, Strada Di Fiume 447, 34100, Trieste, TS, Italy
| | - Hayato Kurihara
- Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Gabriele Bellio
- Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Matteo Porta
- Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Silvia Fattori
- Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy
| | - Gary Alan Bass
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, PA, USA.
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Hashim T, AlTahan YA, Elgassim MA, Zaki HA, Elgassim M, Abdelrahman A. Atypical Presentation and Diagnostic Challenges of Appendicitis in an 85-Year-Old Male: A Case Report. Cureus 2024; 16:e65622. [PMID: 39205785 PMCID: PMC11350477 DOI: 10.7759/cureus.65622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 09/04/2024] Open
Abstract
Acute appendicitis in elderly individuals is uncommon and poses a significant challenge due to atypical symptomatology. An 85-year-old male presented to the emergency department (ED) with abdominal pain associated with nausea and reduced oral intake. Physical examination revealed diffuse abdominal tenderness. He was initially treated for constipation with an enema and discharged. Two days later, the patient returned with worsened pain and a new onset of fever. Examination revealed guarding. Lab results showed significant elevation in C-reactive protein (CRP) and white blood count (WBC). A contrast-enhanced computed tomography (CT) scan showed evidence of a perforated appendix. He was admitted into the surgical ward and improved on conservative treatment. This case describes an atypical presentation of acute appendicitis in an elderly patient, emphasizing the importance of recognizing unusual presentations in this population. Early use of contrast-enhanced CT scans is crucial for accurate diagnosis and improving patients outcomes.
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Affiliation(s)
- Thamir Hashim
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Yara A AlTahan
- Community Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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Yazici H, Ugurlu O, Aygul Y, Ugur MA, Sen YK, Yildirim M. Predicting severity of acute appendicitis with machine learning methods: a simple and promising approach for clinicians. BMC Emerg Med 2024; 24:101. [PMID: 38886641 PMCID: PMC11184860 DOI: 10.1186/s12873-024-01023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUNDS Acute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine Learning (ML) algorithms for simple and complicated AA. METHODS Data regarding operated AA patients between 2012 and 2022 were analyzed retrospectively. Based on operative findings, patients were evaluated under two groups: perforated AA and none-perforated AA. The features that showed statistical significance (p < 0.05) in both univariate and multivariate analysis were included in the prediction models as input features. Five different error metrics and the area under the receiver operating characteristic curve (AUC) were used for model comparison. RESULTS A total number of 1132 patients were included in the study. Patients were divided into training (932 samples), testing (100 samples), and validation (100 samples) sets. Age, gender, neutrophil count, lymphocyte count, Neutrophil to Lymphocyte ratio, total bilirubin, C-Reactive Protein (CRP), Appendix Diameter, and PeriAppendicular Liquid Collection (PALC) were significantly different between the two groups. In the multivariate analysis, age, CRP, and PALC continued to show a significant difference in the perforated AA group. According to univariate and multivariate analysis, two data sets were used in the prediction model. K-Nearest Neighbors and Logistic Regression algorithms achieved the best prediction performance in the validation group with an accuracy of 96%. CONCLUSION The results showed that using only three input features (age, CRP, and PALC), the severity of AA can be predicted with high accuracy. The developed prediction model can be useful in clinical practice.
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Affiliation(s)
- Hilmi Yazici
- General Surgery Department, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey.
| | - Onur Ugurlu
- Faculty of Engineering and Architecture, Izmir Bakircay University, Izmir, Turkey
| | - Yesim Aygul
- Department of Mathematics, Ege University, Izmir, Turkey
| | - Mehmet Alperen Ugur
- General Surgery Department, University of Health Sciences Izmir Bozyaka Research and Training Hospital, Izmir, Turkey
| | - Yigit Kaan Sen
- General Surgery Department, University of Health Sciences Izmir Bozyaka Research and Training Hospital, Izmir, Turkey
| | - Mehmet Yildirim
- General Surgery Department, University of Health Sciences Izmir Bozyaka Research and Training Hospital, Izmir, Turkey
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Zhang Q, Zhao H, Wang F, Li W, Zhang P. Diagnostic value of laboratory parameters for complicated appendicitis: A two‑center study. Biomed Rep 2024; 20:77. [PMID: 38590948 PMCID: PMC10999898 DOI: 10.3892/br.2024.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/06/2024] [Indexed: 04/10/2024] Open
Abstract
There are two types of treatment for acute appendicitis (AA): surgery and antibiotic therapy. Some patients with complex appendicitis are treated with surgery; however, for uncomplex appendicitis, most could be treated effectively with antibiotics instead. How to distinguish complex appendicitis from uncomplex appendicitis before surgery is currently unknown. The present study aimed to assess the efficacy of the laboratory parameters to diagnose complicated appendicitis. Data from 1,514 cases with acute appendicitis who were admitted to Beijing Tsinghua Changgung Hospital and Beijing Aerospace General Hospital (both Beijing, China) from January 2016 to September 2021 were retrospectively analyzed. All cases were divided into uncomplicated and complicated appendicitis. Independent variables were analyzed by uni- and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in the multivariate logistic regression analysis. Cut-off values, sensitivity, specificity and accuracy with area under the curve (AUC)>0.600 were considered significant parameters. Significant differences were found in age (P<0.001), body temperature (P<0.001), white blood cell (WBC) count (P<0.001), C-reactive protein (CRP; P<0.001), neutrophil count (P<0.001), neutrophil-to-lymphocyte ratio (NLR, P=0.019), platelet-to-lymphocyte ratio (PLR, P<0.001), platelet count (P<0.001), coefficient of variation (CV) and standard deviation (SD) of red blood cell distribution width (RDW); both P<0.001), mean platelet volume (MPV, P<0.001) and total (P<0.001) and direct bilirubin (P<0.001) between the two groups. CRP, neutrophil count, NLR, PLR, platelet count, RDW-CV, RDW-SD, MPV and direct bilirubin levels were found as the independent variables to diagnose complicated appendicitis. In patients with acute appendicitis, CRP >22.95 mg/l, NLR >5.7, serum direct bilirubin >6.1 mmol/l and RDW-SD>17.7 fl were significantly associated with complicated appendicitis.
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Affiliation(s)
- Qian Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P.R. China
| | - Hongwei Zhao
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P.R. China
| | - Fangli Wang
- Department of General Surgery, Aerospace Center Hospital, School of Clinical Medicine, Peking University, Beijing 100039, P.R. China
| | - Wenqiang Li
- Department of General Surgery, Aerospace Center Hospital, School of Clinical Medicine, Peking University, Beijing 100039, P.R. China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P.R. China
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Bazzi N, Dbouk S, Rached A, Jaber S, Bazzi H, Jrad M, Bazzi M. An Update on Acute Appendicitis in Lebanon: Insights From a Single-Center Retrospective Study. Cureus 2023; 15:e38792. [PMID: 37303416 PMCID: PMC10250019 DOI: 10.7759/cureus.38792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Acute appendicitis is the most common surgical emergency worldwide with scarce reports about its prevalence in the Middle East. To date, no epidemiological article has described the incidence of appendicitis in Lebanon. Our primary objective was to estimate the rate of appendicitis in a single center in Lebanon. Our secondary objectives included identifying differences between simple and complicated appendicitis regarding demographics, pre and postoperative characteristics, and symptoms and signs of appendicitis. Methodology A retrospective study was conducted at a single central university hospital in Lebanon. Patients with a clear diagnosis of acute appendicitis were included. Pregnant women, lactating women, patients with organ dysfunction, and patients younger than 18 years old or older than 80 years old were excluded. We reviewed and collected the data of patients who presented to the hospital between November 2018 and November 2019 and November 2020 and November 2021. Results A total of 95 patients were included in our study, with 35 women and 60 men. The mean body mass index of patients with simple appendicitis was 19.14 ± 9.66 kg/m2 compared to 18.97 ± 10.37 kg/m2 in patients with complicated appendicitis (p = 0.94). A total of 42.3% of patients who used antibiotics 24 hours after the operation had simple appendicitis, whereas 20.8% had complicated appendicitis (p = 0.004). Conclusions Antibiotic usage and the length of hospital stay were correlated with the severity of appendicitis, as reported in the literature. Further randomized studies with a larger number of patients and covering several hospitals in Lebanon are warranted.
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Affiliation(s)
| | - Samer Dbouk
- General Surgery, Al Zahraa Hospital University Medical Center, Beirut, LBN
| | - Ahmad Rached
- Internal Medicine and Dermatology, Saint Charles Hospital, Beirut, LBN
| | - Sadek Jaber
- Orthopedics, Lebanese University, Beirut, LBN
| | - Hala Bazzi
- Faculty of Science, Lebanese University, Beirut, LBN
| | - Manal Jrad
- Radiology, American University of Beirut, Beirut, LBN
| | - Mariam Bazzi
- Faculty of Public Health, Saint Joseph University of Beirut, Beirut, LBN
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Age-related disparities and trends in national healthcare spending for management of appendicitis in the United States: A retrospective cost-analysis. Surgery 2023; 173:896-903. [PMID: 36642654 DOI: 10.1016/j.surg.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Changes in clinical care for appendicitis have impacted healthcare use associated with treatment. We evaluated national trends and assessed factors associated with healthcare costs for appendicitis in the United States. DESIGN The Disease Expenditure Project, the Global Burden of Disease study, and the National Inpatient Sample were used to estimate total national expenditures, per-capita costs for incident cases, and factors associated with inpatient costs for appendicitis management, respectively. The national estimates of appendicitis costs were obtained from 1996 to 2016. Appendicitis incidence was estimated to calculate per-capita costs. After application of survey weights for the stratified sample design, 191,180 weighted discharges for appendicitis from the 2016 National Inpatient Sample study were evaluated. The Disease Expenditure Project and the Global Burden of Disease study were used to estimate total and per-capita spending. Temporal trends were evaluated using joinpoint regression, expressed as annual percent change. Multivariable linear regression was used to evaluate patient factors associated with total hospital charges. RESULTS In 2016, total spending on appendicitis was $9.3 billion (95% confidence interval: $8.0-$10.8], a 2-fold increase from $4.7 billion ($4.0-$5.3) in 1996. Per-capita spending decreased significantly after 2011 (annual percent change -3.7% [-4.4% to -2.9%]). Patients ≥65 years accounted for 64.1% (61.1%-67.3%) of total spending for appendicitis. The hospital charges for older patients were significantly higher among those undergoing appendectomy. CONCLUSION Overall healthcare spending for appendicitis has doubled from 1996 to 2016, but per capita spending has decreased since 2011, driven by improved efficiency of inpatient care. Nearly two-thirds of spending is on patients ≥65 years, with significantly higher costs associated with surgical management in this population.
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Yang Y, Guo C, Gu Z, Hua J, Zhang J, Qian S, Shi J. The Global Burden of Appendicitis in 204 Countries and Territories from 1990 to 2019. Clin Epidemiol 2022; 14:1487-1499. [PMID: 36536897 PMCID: PMC9758930 DOI: 10.2147/clep.s376665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/01/2022] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE Appendicitis is a common surgical emergency. This study aimed to estimate the worldwide burden and trends of appendicitis from 1990 to 2019. METHODS Data on appendicitis were derived from the Global Burden of Disease 2019. Incidence and disability-adjusted life-years (DALYs) data were analyzed at global, regional, and national levels and stratified by sex, age, and socio-demographic index. The estimated annual percentage change and relative change were used to assess changing trends. Pearson's correlation test was used to assess the correlation between different measures. RESULTS Global incidence grew by 63.55% between 1990 and 2019, age-standardized incidence rate climbed by an estimated percentage change of 0.58 per year, whereas the number of DALY declined by 31.93% during the same period, with an estimated annual percentage change of -2.77. In 2019, the areas of Andean Latin America and the Caribbean had the highest age-standardized rates of incidence and DALYs. While South Asia saw the largest increase in age-standardized incidence rates, Andean Latin America saw the biggest decline in age-standardized rates of incidence and DALYs. At the national level, Bangladesh, Bhutan, and Peru were the top three countries in terms of age-standardized incidence rates in 2019, and Honduras, Haiti, and the Central African Republic held the highest age-standardized DALY rates. Ethiopia experienced the most age-standardized incidence rate increase, and Peru saw the largest decline in age-standardized rate of incidence and DALYs. Significant negative correlations between age-standardized DALY rates and socio-demographic index, between estimated annual percentage change and age-standardized incidence rates, were observed at the national level. CONCLUSION Appendicitis remains a major global health concern. Although the trends in DALYs decreased, the burden of incidence increased from 1990 to 2019. Policymakers should create health policies adapted to local conditions to manage the burden of appendicitis globally.
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Affiliation(s)
- Yongping Yang
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Chengjun Guo
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Zhaoxuan Gu
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Junjie Hua
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jiaxuan Zhang
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Siyu Qian
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jian Shi
- Department of General Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
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Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study. J Clin Med 2022; 11:jcm11154495. [PMID: 35956110 PMCID: PMC9369616 DOI: 10.3390/jcm11154495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p < 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.
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Stevens A, Meier J, Bhat A, Bhat S, Balentine C. Age is associated with increased morbidity after laparoscopic appendectomy. Surgery 2022; 172:488-493. [PMID: 35568586 PMCID: PMC10370360 DOI: 10.1016/j.surg.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/05/2022] [Accepted: 04/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic appendectomy is one of the most common emergency general surgery procedures in the United States. Little is known about its postoperative outcomes for older adults because appendicitis typically occurs in younger patients. The purpose of this study was to examine the association between age and postoperative complications after appendectomy. We hypothesized that age would have a significant and nonlinear association with morbidity. METHODS We conducted a retrospective cohort study of individuals whose laparoscopic appendectomies were recorded in the Veterans Affairs (VA) Surgical Quality Improvement Program (from 2000-2018; n = 14,619) and National Surgical Quality Improvement Program (2005-2019; n = 349,909) databases. The primary outcome was 30-day morbidity. We used logistic regression with fractional polynomials to model nonlinear relationships between age and outcomes. RESULTS The median age (interquartile range) of the nonveteran cohort was 36 years (26-51; 8.4% of patients were 65 or older) versus 51 years among veterans (35-63; 21% were 65 or older). For veterans and nonveterans, there was a significant and nonlinear relationship between age and risk of complications. In the nonveteran cohort, the predicted probability (with 95% confidence interval) of postoperative complications was 9.8% (9.7-10.1) at age 65, 11.9% (11.7-12.3) at age 75, and 14.5% (14.1-14.9) at age 85. Among veterans, the risk was 7.5% (6.9-8.1) at age 65, 8.3% (7.6-9.1) at age 75, and 9.1% (8.1-10.1) at age 85. CONCLUSION For both veterans and nonveterans, older age was associated with a significantly increased risk of postoperative complications. Notably, morbidity within the VA was lower for older adults than in non-VA hospitals.
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Affiliation(s)
- Audrey Stevens
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX.
| | - Jennie Meier
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX. https://twitter.com/Jenniemeier
| | - Archana Bhat
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX. https://twitter.com/bhats7637
| | - Sneha Bhat
- University of Texas Southwestern Department of Surgery, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX
| | - Courtney Balentine
- University of Texas Southwestern Department of Surgery, Dallas, TX; VA North Texas Healthcare System, Dallas, TX; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, TX
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11
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Yuan J, Chen Q, Hong W, Yu L, Li X. Comparison of Clinical Features and Outcomes of Appendectomy in Elderly vs. Non-Elderly: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:818347. [PMID: 35265661 PMCID: PMC8899017 DOI: 10.3389/fsurg.2022.818347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background The objective of this study is to compare clinical and surgical outcomes of appendectomy among elderly and non-elderly subjects. Methods A systematic search was conducted on PubMed, Scopus, and Google academic databases. Studies, observational in design, that compared peri-and postoperative outcomes of appendectomy, in patients with acute appendicitis, between elderly and non-elderly/younger subjects were considered for inclusion. Statistical analysis was performed using STATA software. Results A total of 15 studies were included. Compared to non-elderly patients, those that were elderly had an increased risk of complicated appendicitis [relative risk (RR), 2.38; 95% CI: 2.13, 2.66], peritonitis [RR, 1.88; 95% CI: 1.36, 2.59], and conversion from laparoscopic to open appendectomy [RR, 3.02; 95% CI: 2.31, 3.95]. The risk of overall postoperative complications [RR, 2.59; 95% CI: 2.19, 3.06], intra-abdominal abscess [RR, 1.84; 95% CI: 1.15, 2.96], wound infection [RR, 3.80; 95% CI: 2.57, 5.61], and use of postoperative drainage [RR, 1.14; 95% CI: 1.09, 1.19] was higher among the elderly. The risk of readmission (30 days) [RR, 1.61; 95% CI: 1.16, 2.24] and mortality (30 days) [RR, 12.48; 95% CI: 3.65, 42.7] was also higher among elderly. Conclusions Findings suggest an increased risk of peri-and postoperative complications among elderly subjects undergoing appendectomy, compared to non-elderly subjects. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021286157.
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Affiliation(s)
- Jie Yuan
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
| | - Qingfeng Chen
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo Hospital of the Zhejiang University, Ningbo, China
| | - Weicong Hong
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
| | - Lifeng Yu
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
| | - Xuen Li
- Department of General Surgery, Longshan Hospital of Cixi City, Ningbo, China
- *Correspondence: Xuen Li
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Lapsekili E, Deniz A, Celik SU. Factors associated with postoperative complications following appendectomy in elderly patients. Rev Assoc Med Bras (1992) 2021; 67:1485-1490. [PMID: 35018980 DOI: 10.1590/1806-9282.20210672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 11/22/2022] Open
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Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem. Geriatrics (Basel) 2021; 6:geriatrics6030093. [PMID: 34562994 PMCID: PMC8482159 DOI: 10.3390/geriatrics6030093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
With increased life expectancy and the growing total population of elderly patients, there has been rise in the number of cases of acute appendicitis in elderly people. Although acute appendicitis is not the most typical pathological condition in the elderly, it is not uncommon. Most of these patients require surgical treatment, and as with any acute surgical pathology in advanced age, treatment possibilities are affected by comorbidities, overall health status, and an increased risk of complications. In this literature review we discuss differences in acute appendicitis in the elderly population, with a focus on clinical signs, diagnostics, pathogenesis, treatment, and results.
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[Acute appendicitis-Not only a clinical picture of childhood and adolescence]. Z Gerontol Geriatr 2021; 54:446-447. [PMID: 34081186 DOI: 10.1007/s00391-021-01914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
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