Outcomes of acute appendicitis in elderly patients: a 5-year experience at a single institution

Yıl 2013, Cilt: 2 Sayı: 1, 40 - 46, 05.04.2013

Ali Gökakın , Mustafa Atabey Elif Uysal Köksal Deveci Ayhan Koyuncu Ömer Topçu

https://doi.org/10.12808/bcs.v2i1.22

Öz

Abstract

Aim. Outcomes after elective surgical procedures are seemed as if similar in younger and older patients; however, urgent surgeries may cause significant morbidity and mortality in older patients. The aim of study was to present our management experience on acute appendicitis in elderly patient group. Methods. Patients who underwent appendectomy for acute appendicitis between 2007- 2012 were included in the study. Individuals with other reasons of acute abdomen not defined as acute appendicitis were excluded. With these criteria, 1382 patients were included in the study. Patients were divided into three age groups: group I; younger than 29, group II; 29 to 65, and group III; 65 and older. Variables selected for analysis included age, sex, duration of symptoms, duration of hospitalization (total and preoperative), operative approach, operative findings, operative time, morbidity and mortality rates, and pathological confirmation. Results. Duration of symptoms and hospitalization (total and preoperative) were higher in the group III. Post-operative outcomes were worse in the group III compared to the other groups. However, miss diagnosis rate was lower in that age group. Conclusions. Acute appendicitis in the elderly remains a challenge for practicing surgeons and continues to be associated with high morbidity. With increasing life expectancy, more such cases are likely to be encountered in the future.

Keywords: Appendicitis, aged, outcome

Özet

Amaç. Genç ve yaşlı hastalarda elektif cerrahi işlemlerin sonuçları benzer görülse de, yaşlılarda acil cerrahiler önemli morbidite ve mortaliteye yol açabilir. Bu çalışma yaşlı hasta grubunda akut apandisit yönetimindeki tecrübemizi sunmak amacıyla yapıldı. Yöntem. 2007-2012 yılları arasında akut apandisit nedeniyle apandektomi yapılan hastalar çalışmaya alındı. Diğer akut batın nedenleri saptanan olgular çalışma dışı tutuldu. Bu koşullara göre 1382 olgu çalışma kapsamında değerlendirildi. Çalışmaya alınan olgular üç yaş grubuna bölündü: grup I, yaş<29; grup II, yaş 29-65; ve grup III, 65 yaş ve üzeri. Yaş, cinsiyet, belirtilerin süresi, hastanede yatış süresi (toplam ve preoperatif), ameliyat tipi, bulguları ve ameliyat süresi, morbitite ve mortalite oranları ve patolojik bulguların uyumluluğu verileri değerlendirildi. Bulgular. Belirtilerin süresi ve hastanede yatış süresi (toplam ve preoperatif) grup III'de daha fazla bulundu. Postoperatif sonuçlar grup III olgularda diğer gruplara göre daha kötü bulundu; ama yanlış tanı oranı diğer gruplara göre daha düşüktü. Sonuçlar. Yaşlılarda akut apandisit cerrahi pratiğinin zor kısımlarından biridir ve daha yüksek morbidite ile birliktedir. Yaşam süresinin artması ile birlikte gelecekte bu olgularla daha fazla karşılaşılacağı beklenilmelidir.

Anahtar sözcükler: Apandisit, yaşlılık, klinik sonuç

Anahtar Kelimeler

Appendicitis, aged, outcome

Kaynakça

• Mirbagheri N, Dark JG, Watters DA. How do patients aged 85 and older fare with abdominal surgery? J Am Geriatr Soc. 2010; 58:104-8.
• Pofahl WE, Pories WJ. Current status and future directions of geriatric general surgery. J Am Geriatr Soc. 2003; 51:351-4.
• Moon KS, Jung YH, Lee EH, Hwang YH. Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80. J Korean Soc Coloproctol. 2012; 28:94Lunca S, Bouras G, Romedea NS. Acute appendicitis in the elderly patient: diagnostic problems, prognostic factors and outcomes. Rom J Gastroenterol. 2004; 13:299-303.
• Lee JF, Leow CK, Lau WY. Appendicitis in the elderly. Aust N Z J Surg. 2000; 70:593-6.
• Harbrecht BG, Franklin GA, Miller FB, Smith JW, Richardson JD. Acute appendicitis--not just for the young. Am J Surg. 2011; 202:286-90.
• Massarweh NN, Legner VJ, Symons RG, McCormick WC, Flum DR. Impact of advancing age on abdominal surgical outcomes. Arch Surg. 2009; 144:1108-14.
• Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH. Incidence of acute nonperforated and perforated appendicitis: age-specific and sexspecific analysis. World J Surg. 1997; 21:313-7.
• McGowan DR, Howlader MH, 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 J Surg. 2011; 9:669-71.
• Fleming FJ, Kim MJ, Messing S, Gunzler D, Salloum R, Monson JR. Balancing the risk of postoperative surgical infections: a multivariate analysis of factors associated with laparoscopic appendectomy from the NSQIP database. Ann Surg. 2010; 252:895-900.
• Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA, Pruitt BA Jr, Root HD. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000; 66:548-54.
• Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Oprian CA, Henderson WG, Daley J, Khuri SF. Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg. 2003; 238:59-66.
• Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132:910-25.
• Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP. Appendectomy: a contemporary appraisal. Ann Surg. 1997; 225:252-61.
• Luckmann R. Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age. Am J Epidemiol. 1989; 129:905-18.
• Baek HN, Jung YH, Hwang YH. Laparoscopic versus open appendectomy for appendicitis in elderly patients. J Korean Soc Coloproctol. 2011; 27:241-5.
• Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ. Does Laparoscopic Appendectomy Impart an Advantage over Open Appendectomy in Elderly Patients? World J Surg. 2012; 36:1534-9.
• Wu HS, Lai HW, Kuo SJ, Lee YT, Chen DR, Chi CW, Huang MH. Competitive edge of laparoscopic appendectomy versus open appendectomy: a subgroup comparison analysis. J Laparoendosc Adv Surg Tech A. 2011; 21:197-202.