Management of Complicated Appendicitis in the Elderly: Timing of Surgery Impacts Outcomes?

Objective: Our objective was to compare outcomes of initial operative and non-operative management for complicated appendicitis in elderly patients. Methods: We conducted a population-based, retrospective cohort review... [ view full abstract ]

Objective: Our objective was to compare outcomes of initial operative and non-operative management for complicated appendicitis in elderly patients.

Methods: We conducted a population-based, retrospective cohort review using the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for the states of California and Florida. Geriatric patients (>65 years) with a principal diagnosis of complicated appendicitis between 2006 and 2011 were included. Initial surgical management (SM) was defined as surgery within 48 hours of index admission and medical management (MM) as either no surgery during index admission or failure of medical management (surgery > 48 hours from admission). Propensity scores were assigned based on group membership using covariates selected with stepwise forward logistic regression (p<0.05). Multivariable analysis of paired groups was performed using conditional logistic regression.

Results: We identified 13,210 patients who met our inclusion criteria. 11,116  (82.6%) patients were in the SM group and 2,094 (17.3%) were in the MM group, with 977 (7.4%) of the MM group ultimately requiring surgery. Patients with initial MM had greater inpatient mortality (6.26% vs 1.5%, p<0.001) and 30-day mortality (7.02% vs. 1.85%, p<0.001). After propensity matching, (n=1,210 MM, n=1,210 SM), those with initial MM had increased odds of inpatient mortality (OR=2.53, p<0.001) and 30-day mortality (OR=2.23, p<0.001) compared to SM patients.

Conclusions:  Initial medical management of elderly patients with complicated appendicitis confers increased risk of mortality compared with initial surgical management. This risk of mortality persists after controlling for patient characteristics and comorbid disease.