ORIGINAL ARTICLE   Free

Minerva Chirurgica 2019 October;74(5):374-8

DOI: 10.23736/S0026-4733.18.07715-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Perforated vs. nonperforated acute appendicitis: evaluation of short-term surgical outcomes in an elderly population

Fabio RONDELLI ^{1, 2}, Michele DE ROSA ¹ ✉, Paolo STELLA ¹, Marcello BONI ¹, Graziano CECCARELLI ³, Ruben BALZAROTTI ⁴, Andrea POLISTENA ⁵, Alessandro SANGUINETTI ⁵, Walter BUGIANTELLA ¹, Nicola AVENIA ⁵

¹ Department of General Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, Foligno, Perugia, Italy; ² Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; ³ Unit of Minimally Invasive and General Surgery, Department of Medicine and General Surgery, “San Donato” Hospital, ASL 8 Arezzo, Arezzo, Italy; ⁴ Department of General and Visceral Surgery, Civico Hospital, Lugano, Switzerland; ⁵ Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy

BACKGROUND: Acute appendicitis is a common acute surgical abdominal condition and despite the majority of cases are observed in children and young adults, its occurrence in the elderly seems to be increasing, with a higher risk of perforation. The aim of this study was to evaluate the surgical outcomes following appendectomy for acute appendicitis in the elderly, making a comparison between perforated and nonperforated groups regarding operative time, hospital stay and postoperative complications.
METHODS: The medical records of 48 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis from January 2011 to December 2016 were retrospectively reviewed. Patients were grouped into those with perforated and those with non-perforated appendicitis (NPA) and a comparison was made between both groups regarding demography, operative time, length of hospital stay and postoperative complications.
RESULTS: From 48 patients over 60 years diagnosed with acute appendicitis, a PA was removed from 10 patients (20.8%). The PA group consisted of 3 males and 7 females, and their mean age was 71.6 years (range 65-84). The NPA group included 22 males and 16 females, and their mean age was 76.5 years (range 63-96). The mean operative time was 58±18.7 minutes and 43.3±9.9 minutes in the perforated and nonperforated groups respectively, with statistically significant difference (P=0.0013). The mean length of hospital stay was similar in the PA group and in the NPA group, being 6.5±1.8 days and 5.4±1.8 days respectively, but these differences were not statistically significant (P=0.093). The frequency of postoperative complications was similar in both groups as they were observed in 3 patients (30%) of the PA group and 10 patients (26%) of the NPA group (P=0.2488). No postoperative intraabdominal abscess was observed in both groups and there was no death after the surgery.
CONCLUSIONS: PA, despite requiring a longer mean operative time, in our series is not producing a longer hospital stay or more postoperative complications compared to NPA. The non-operative management of uncomplicated appendicitis is a reasonable option in frail patients in order to avoid the burden of morbidity related to operation, nevertheless surgery remains the standard of care in all age groups.

KEY WORDS: Appendicitis; Laparoscopy; Aged