Clinical-pathological features and treatment of acute appendicitis in the very elderly: an interim analysis of the FRAILESEL Italian multicentre prospective study

• Published in: European journal of trauma and emergency surgery (Munich : 2007) 2022-04, Vol.48 (2), p.1177-1188
• Main Authors: Fransvea, Pietro, Fico, Valeria, Cozza, Valerio, Costa, Gianluca, Lepre, Luca, Mercantini, Paolo, La Greca, Antonio, Sganga, Gabriele
• Format: Article
• Language: English
• Subjects: Abdominal surgery; Acute Disease; Aged; Aged, 80 and over; Appendectomy - methods; Appendicitis; Appendicitis - complications; Clinical outcomes; Critical Care Medicine; Emergency medical care; Emergency Medicine; Humans; Intensive; Laparoscopy - methods; Length of Stay; Medicine; Medicine & Public Health; Mortality; Oldest old people; Original Article; Pathology; Postoperative Complications - surgery; Prospective Studies; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-021-01645-9

Background Emergency abdominal surgery in the elderly represents a global issue. Diagnosis of AA in old patients is often more difficult. Appendectomy remains the gold standard of treatment and, even though it is performed almost exclusively with a minimally invasive technique, it can still represent a great risk for the elderly patient, especially above 80 years of age. A careful selection of elderly patients to be directed to surgery is, therefore, fundamental. The primary aim was to critically appraise and compare the clinical–pathological characteristics and the outcomes between oldest old (≥ 80 years) and elderly (65–79 years) patients with Acute Appendicitis (AA). Methods The FRAILESEL is a large, nationwide, multicentre, prospective study investigating the perioperative outcomes of patients aged ≥ 65 years who underwent emergency abdominal surgery. Particular focus has been directed to the clinical and biochemical presentation as well as to the need for operative procedures, type of surgical approach, morbidity and mortality, and in-hospital length of stay. Two multivariate logistic regression analyses were performed to assess perioperative risk factors for morbidity and mortality. Results 182 patients fulfilled the inclusion criteria. Mean age, ileocecal resection, OAD and ASA score ≥ 3 were related with both overall and major complication. The multivariate analysis showed that MPI and complicated appendicitis were independent factors associated with overall complications. OAD and ASA scores ≥ 3 were independent factors for both overall and major complications. Conclusions Age ≥ 80 years is not an independent risk factor for morbidities. POCUS is safe and effective for the diagnosis; however, a CECT is often needed. Having the oldest old a smaller functional organ reserve, an earlier intervention should be considered especially because they often show a delay in presentation and frequently exhibit a complicated appendicitis.