Advantages/Disadvantages of Appendectomies Performed in Geriatric Age for Acute Appendicitis Compared to Appendectomies Performed in Non-Geriatric Age

Year 2023, Volume: 1 Issue: 2, 49 - 52, 22.06.2023

Mesud Fakirullahoğlu , Mustafa Yeni , Mehmet Hamdi Sakarya

Abstract

Aim: This study compared the advantages/disadvantages of appendectomies performed in geriatric age due to acute appendicitis (AA) compared to appendectomies performed before geriatric age.
Materials and Methods: Patients who underwent surgery for AA in the XXX between October 2019 and October 2022, after obtaining the ethics committee’s approval, were evaluated retrospectively. Patients under the age of 65 were grouped as the non-geriatric group, and patients aged 65 and over were grouped as the geriatric population. Preoperative, peroperative and postoperative characteristics between groups were evaluated with appropriate statistical tests.
Results: 393 patients met the study criteria, and the mean age of the patients was 34.58 years (18-93). Of the patients, 240 (61.1%) were male, and 153 (38.9%) were female. As a result of preoperative examinations, 350 (89.1) patients were diagnosed with non-complicated AA. Complications developed in 20.1% (n=79) of the patients in the postoperative period, and the most common complication was port site infection. In the geriatric population, the rate of female sex (p<0.001) and the rate of cases thought to have complicated appendicitis in the preoperative period (p=0.023) were higher. In contrast, the white blood cell count (p=0.047), haemoglobin levels (p=0.033) and neutrophil-lymphocyte ratios (p=0.048) were more higher in the non-geriatric population.
Conclusion: AA cases in both the non-geriatric and the geriatric populations show similar features in terms of postoperative outcomes, apart from diagnostic differences, and early diagnosis and treatment are extremely important in the successful management of cases.

Keywords

Appendicitis, morbidity, aged

Akut Apandisit Nedeniyle Geriatrik Yaşta Yapılan Apendektomilerin Geriatrik Olmayan Yaşta Yapılan Apendektomilere Göre Avantaj/Dezavantajları

Abstract

Amaç: Bu çalışmada akut apandisit (AA) nedeniyle geriatrik yaşta yapılan apendektomilerin geriatrik yaştan önce yapılan apendektomilere göre avantaj/dezavantajları karşılaştırıldı.
Gereç ve Yöntem: Ekim 2019-Ekim 2022 tarihleri arasında XXX hastanesinde etik kurul onayı alındıktan sonra AA nedeniyle ameliyat edilen hastalar retrospektif olarak değerlendirildi. 65 yaş altı hastalar non-geriatrik grup olarak, 65 yaş ve üzeri hastalar ise geriatrik grup olarak gruplandırıldı. Gruplar arası preoperatif, peroperatif ve postoperatif özellikler uygun istatistiksel testlerle değerlendirildi.
Bulgular: 393 hasta çalışma kriterlerini karşıladı ve hastaların yaş ortalaması 34,58 (18-93) idi. Hastaların 240'ı (%61,1) erkek, 153'ü (%38,9) kadındı. Preoperatif yapılan tetkikler sonucunda 350 (89,1) hastaya komplike olmayan AA tanısı kondu. Ameliyat sonrası dönemde hastaların %20,1'inde (n=79) komplikasyon gelişti ve en sık görülen komplikasyon port yeri enfeksiyonuydu. Geriatrik popülasyonda kadın cinsiyet oranı (p<0,001) ve preoperatif dönemde komplike apandisit düşünülen olgu oranı (p=0,023) daha yüksekti. Buna karşılık beyaz küre sayısı (p=0,047), hemoglobin düzeyleri (p=0,033) ve nötrofil-lenfosit oranları (p=0,048) geriatrik olmayan popülasyonda daha yüksekti.
Sonuç: Hem non-geriatrik hem de geriatrik popülasyondaki AA olguları, tanısal farklılıklar dışında postoperatif sonuçlar açısından benzer özellikler göstermekte olup, erken tanı ve tedavi olguların başarılı yönetilmesinde son derece önemlidir.

Keywords

Apandisit, morbidite, yaşlı

References

• Kartal M, Kalaycı T, Çöpelci Y, Ali K. Clinicopathological evaluation of parasitic infections in appendectomy specimens. Arch Curr Med Res. 2023;4(1):40-6.DOI: 10.47482/acmr.1141714
• Omari AH, Khammash MR, Qasaimeh GR, Shammari AK, Yaseen MKB, Hammori SK. Acute appendicitis in the elderly: risk factors for perforation. World J Emerg Surg. 2014;9(1):1-6.DOI: 10.1186/1749-7922-9-6
• Shchatsko A, Brown R, Reid T, Adams S, Alger A, Charles A. The utility of the Alvarado score in the diagnosis of acute appendicitis in the elderly. Am Surg. 2017;83(7):793-8.
• McGowan D, Howlader M, Patel R, Swindlehurst N, Manifold D, Shaikh I. Management and outcome of appendicitis among octogenarians in an English hospital over a five year period. Int JSurg. 2011;9(8):669-71.DOI: 10.1016/j.ijsu.2011.10.004
• Cibert-Goton V, Kung VW, McGuire C, et al. Functional and anatomical deficits in visceral nociception with age: a mechanism of silent appendicitis in the elderly? Pain. 2020;161(4):773- 86.DOI: 10.1097/j.pain.0000000000001764
• Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15:1-42.DOI: 10.1186/s13017-020-00306-3
• Bhullar JS, Chaudhary S, Cozacov Y, Lopez P, Mittal VK. Acute appendicitis in the elderly: diagnosis and management still a challenge. Am Surg. 2014;80(11):295-7.
• Kalaycı T, Balcı S. Factors Affecting Morbidity in Appendectomy: A Single Center Experience. Turk JColorectal Dis. 2022;32(1).DOI: 10.4274/tjcd.galenos.2021.2021-3-2
• Ahmed HO, Muhedin R, Boujan A, et al. A five-year longitudinal observational study in morbidity and mortality of negative appendectomy in Sulaimani teaching Hospital/Kurdistan Region/Iraq. Sci Rep. 2020;10(1):2028.DOI: 10.1038/s41598-020-58847-1
• Martin RF, Kang SK. Acute appendicitis in adults: Diagnostic evaluation. https://www uptodate com/contents/acute-appendicitis-in-adults-diagnostic-evaluation [Erişim tarihi: 08/04/2023].
• Ghnnam WM. Elderly versus young patients with appendicitis 3 years experience. Alexandria J Med. 2012;48(1):9-12. DOI:10.1016/j.ajme.2011.10.004
• Kraemer M, Franke C, Ohmann C, Yang Q, Group AAPS. Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature. Langenbecks Arch Surg. 2000;385:470-81.DOI: 10.1007/s004230000165
• Hong YR, Chung C-W, Kim JW, et al. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis. J Korean Soc Coloproctol. 2012;28(5):247-52.DOI: 10.3393/ jksc.2012.28.5.247
• Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2013;97(4):299- 304.DOI: 10.9738/CC161.1
• Kalayci T, Kartal M. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum albumin and prognostic nutritional index as predictors of morbidity in super-elderly patients operated on for acute appendicitis. Eur Rev Med Pharmacol Sci. 2022;26(3):820-7.DOI: 10.26355/eurrev_202202_27990
• Bayrak S, Tatar C, Cakar E, et al. Evaluation of the predictive power of laboratory markers in the diagnosis of acute appendicitis in the elderly. North Clin Istanb. 2019;6(3):293-301.DOI: 10.14744/nci.2019.93457
• Segev L, Keidar A, Schrier I, Rayman S, Wasserberg N, Sadot E. Acute appendicitis in the elderly in the twenty-first century. J Gastrointest Surg. 2015;19:730-5.DOI: 10.1007/s11605- 014-2716-9
• Andert A, Alizai H, Klink C, et al. Risk factors for morbidity after appendectomy. Langenbecks Arch Surg. 2017;402:987-93.DOI: 10.1007/s00423-017-1608-3
• Calis H. Morbidity and Mortality in Appendicitis in the Elderly. J Coll Physicians Surg Pak. 2018;28(11):875-8.DOI: 10.29271/jcpsp.2018.11.875
• Sheu BF, Chiu TF, Chen JC, Tung MS, Chang MW, Young YR. Risk factors associated with perforated appendicitis in elderly patients presenting with signs and symptoms of acute appendicitis. ANZ JSurg. 2007;77(8):662-6.DOI: 10.1111/j.1445-2197.2007.04182.x
• Bos C, Doumouras AG, Akhtar-Danesh G-G, Flageole H, Hong D. A population-based cohort examining factors affecting all-cause morbidity and cost after pediatric appendectomy: Does annual adult procedure volume matter? AmJ Surg. 2019;218(3):619-23.DOI: 10.1016/j. amjsurg.2018.12.021