Practice patterns and clinical outcomes in acute appendicitis differ in the elderly patient
Authors: Cimino Matteo Maria , Biloslavo Alan , Kurihara Hayato , Bellio Gabriele , Porta Matteo , Fattori Silvia , Bass Gary Alan ,   for the ESTES SnapAppy Group, Bass Gary Alan , Mohseni Shahin , Kaplan Lewis J. , Ahl-Hulme Rebecka , Biloslavo Alan , Cao Yang , Forssten Maximilian Peter , Kurihara Hayato , Martinez-Casas Isidro , Pereira Jorge , Pourlotfi Arvid , Ryan Éanna J. , Tolonen Matti , Louri Nayef , Nedham Fatema , Walsh Thomas Noel , Hashem Jamal , Corbally Martin , Farhan Abeer , Al Hamad Hamad , Elhennawy Rawan , AlKooheji Mariam , AlYusuf Manar , Aknouche Wissal , Zeidan Anas A. , Alsaffar Yusuf S. , Lipping Edgar , Talving Peep , Saar Sten , Graumann Katrina , Kibuspuu Liis , Harkov Eduard , Aaltonen Gisele , Sillman Iines S. , Haapanen Sami , Lampela Hanna , Sammalkorpi Henna , Eskola Sofia , Laakso Altti , Back Johan , Kettunen Ulla , Nummi Antti M. , Szwedyc Anika , Nykänen Taina , Rantala Rolle , Mäkäräinen-Uhlbäck Elisa J. , Meriläinen Sanna A. , Huhta Heikki I. , Rintala Jukka M. J. , Laitakari Kirsi E. M. , Lietzen Elina , Salminen Paulina , Rapola Risto K. A. , Zangouri Vahid , Karami Mohammad Y. , Tahmasebi Sedigheh , Akrami Majid , Golchini Alireza , Bahrami Faranak , Johnston Sean M. , Lim Sean T. , Ahonkhai Irele Ifijeh , Eltagani Eltahir , Ryan Odhran K. , O’Driscoll-Collins Ailbhe , O’Neill Aine , Penny Zakiya , Kelly Orlaith , Cullinane Carolyn , Reynolds Ian , Heneghan Helen , Martin Sean , Winter Des , Davey Matthew , Alkhattab Maha , Lowery Aoife J. , Kerin Michael J. , Hogan Aisling M. , Davey Martin S. , Oh Ke En , Kabir Syed Mohammad Umar , Huan Huilun , Aziz Charlotte , Sugrue Michael , Ryan Jessica M. , Connelly Tara M. , Alhazmi Mohammad , Al-Mukhaizeem Youssef , Cooke Fiachra , Neary Peter M. , Hill Arnold D. K. , Boland Michael R. , Lloyd Angus J. , Fallon Frances , Cleere Eoin F. , Toale James , Boland Patrick A. , Devine Michael , Keady Conor , Hunter Sarah , Barry M. Kevin , Kelly Michael E. , O’Dowling Aidan T. , Creavin Ben , Kavanagh Dara O. , Neary Paul , Ridgway Paul F. , McCarrick Cathleen A. , Bolger Jarlath , Maguire Barry , Keogh Cian , Chawla Surbhi , Conneely John , McCormack Emilie , Shanahan Ben , Raftery Nicola , Rice Darragh , McInerney Niall , Stakelum Aine , Mares Jan , Tan Jonavan , Hanna Mark , Balasubramanian Ishwarya , Fleming Christina , Barsky Guy , Shaked Gad , Giudici Simone , Ceolin Martina , Mei Simona , Mazzarella Francesca , Zucca Annalisa , Terranova Susanna , de Manzini Nicolo , Visconti Diego , Doria Emanuele , Santarelli Mauro , Scotton Giovanni , Notte Francesca , Bertelli Giacomo , Malpaga Anna , Armatura Giulia , Frena Antonio , Tartaglia Dario , Coccolini Federico , Cremonini Camilla , Cicuttin Enrico , Mazzoni Alessio , Chiarugi Massimo , Azevedo Constança M. , Mendes Filipa D. , Faria Luis Q. , Nazario Carlos , Machado Daniela , Semiao Miguel , Pereira Jorge , Casimiro Carlos , Pinto Jose , Pavão Tiago , Pereira Raquel , Barbosa Bruno , Tenreiro Nadia , Ferreira Catia , Guidi Goncalo , Martins Daniela C. , Leal Clara , Vieira Bruno B. , Castro Luís S. , Faria Aldara , Figueira Alberto , Sousa Mauro , Rodrigues Pedro , Roquette Rodrigo , Ribeiro Ricardo , Cardoso Paulo , Domingues Joana , Manso Maria Isabel , Pereira Rute , Revez Tatiana , Dumbrava Bogdan D. , Turcu Florin , Hutopila Ionut , Banescu Bogdana , Filip Gerald , Copaescu Catalin , Valmorisco Marcos Alba , Martín Isabel Manzano , de Arboleya Rocio Martín García , Seda José Ortega , González Pablo Rodríguez , Toro Jose Antonio Becerra , Lara Enrique Rodríguez , Minchón Jose Antonio González , Segura-Sampedro Juan José , Jerí-McFarlane Sebastián , Gil-Catalán Alejandro , Craus-Miguel Andrea , Fernández-Vega Laura , González-Argenté Xavier , Estaire-Gómez Mercedes , Fernández-Pacheco Borja Camacho , Vitón-Herrero Rebeca , Jimenez-Higuera Elisa , Barbero Alejandro , Valverde José M. , Colás-Ruiz Enrique , del Mar Escales-Oliver Maria , Claramonte-Bellmunt Olga , Castro-Suárez Marta , Pagés-Valle Naila , Cifuentes-Ródenas José Andrés , Alvarez Marta Merayo , Campos Jose Luis Michi , González Luis Alejandro García , Aguilera Beatriz Carrasco , Menéndez Jaime Iturbe , Miravalles Jose Luis Rodicio , Haro Carmen Rodríguez , O’Sullivan Sara Núñez , Virosta Mariana García , O’Reilly María Hernández , Balciscueta-Coltell Izaskun , Lorenzo-Perez Javier , Martinez-Alcaide Sonia , Martinez-Ramos Susana , Sebastian-Fuertes Maria , Gomez-Romer Laura , Pelloni Maria M. , Rahy-Martín Aida Cristina , Yepes-Cano Andrés Felipe , Reguera-Rosal Julio , Lopez-Ruiz Jose A. , Marenco Beatriz , Retamar-Gentil Marina , Romero-Vargas Estela , Gil-Olarte Angeles , Landaluce-Olavarria Aitor , Estraviz-Mateos Begoña , De Francisco-Rios Jose-Mario , Sainz-Lete Aitor , Emaldi-Abasolo Ane , Leon-Valarezo Manolo , Moreira Claudia C. Lopes , Perez Aintzane Lizarazu , Gonzalez Araceli Rodriguez , Ponce Iñigo Augusto , Iglesias Ignacio Maria Goena , González-Prado Cristina , Cabriada Guillermo , López Beatriz , Otero Michelle C. , Muñoz-Plaza Nerea , Palomo Alberto , Mendoza-Moreno Fernando , Díez-Alonso Manuel , García-Moreno-Nisa Francisca , Matías-García Belén , Ovejero-Merino Enrique , Quiroga-Valcárcel Ana , Sánchez-Guillén Luis , Oller-Navarro Inmaculada , Soler-Silva Álvaro , Sanchís-López Antonio Francisco , Blanco-Antona Francisco , Muñoz-Bellvis Luis , López-Sánchez Jaime , Garrosa-Muñoz Sonsoles , Barón-Salvador Beatriz , Nieto-Arranz Juan Manuel , Campos-Serra Andrea , Gràcia-Roman Raquel , Muñoz-Campaña Anna , Zerpa-Martin Carla , Torrecilla-Portoles Andrea , Landa Tessa , Muñoz-Cruzado Virginia Durán , Pareja-Ciuró Felipe , Aparicio-Sánchez Daniel , del Pozo Eduardo Perea , Dios-Barbeito Sandra , García-Sánchez Carlos , García-Moriana Antonio Jesús , Turrado-Rodriguez Victor , Termes-Serra Roser , Gonzalez-Atienza Paula , Morales-Sevillano Xavier , Torroella Alba , Ginestà César , Escartín Alfredo , Gomez Ferney , Pinillos Ana , Ortega Jaume , Lopez Guillermo , Gutierrez Eric , Membrilla-Fernandez Estela , Ocho-Segarra Francisco , González-Castillo Ana María , Pelegrina-Manzano Amalia , Guzmán-Ahumada Juan , Sancho-Insenser Juan Jose , García-Jiménez María Lourdes , Castro-Diez Laura , González-Bermúdez Manuel , Torres-Díaz Mónica , Pena Carla Madarro , Rodríguez Angélica Blanco , Trivedi Dhanisha , Reda Souheil , Edvardsson Hans , Strömmer Lovisa , Caragounis Eva-Corina , Sillén Karin , Warfvinge Sofia , Bergstedt Fredrik , Enström Philip , Olsson Harald , Rosemar Anders , Young Nathalie , Popowicz Agnieszka , Lerström Johanna , Jäderbo Johanna , Hammarqvist Folke , Zacharias Hanna , Wikström Maria B. , Hurtsén Anna Stene , Bayadsi Haytham , Jansson Emma , Brunstrom Nils , Malers Ellen B. , Loftås Per I. , Möller Anders , Atanasova Elena , Zwicky Simone N. , Schnüriger Beat , Rutka Olga , Kattakayam Arjun T. , Alam Mushfique , Taylor John V. , Mihailescu Andrei , Karip Eszter T. , Zeb Ehtisham , O’Connor Adam , Pokusevski Goran , Khan Mansoor , Florance Charlotte , Swaminathan Christie , Jaunoo Shameen , Sajid Mohammed , Duffy Caoimhe C. , Rees John , Seamon Mark J. , Martin Niels D. , McCurry Ian J. , Vail Emily A. , Bormann Bradford C. , Cullinane Daniel C. , Sawhney Jaswin S. , Dreifus Jonathan , Sheppard Forest R. , Coimbra Raul , Albini Paul , Edwards Sara 
Published: August 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.