Nonoperative vs operative management of acute appendicitis in older adults

Editor's Note

This study from the University of Texas Southwestern, Dallas, finds that nonoperative management of acute appendicitis was associated with reduced complications in older but not younger patients.

Included in the analysis was data from the Agency for Healthcare Research and Quality’s National Inpatient Sample on 474,845 patients with acute uncomplicated appendicitis. Of these, 43,846 were managed nonoperatively.

Among the findings:

• In patients 65 years and older, nonoperative management was associated with a 3.72% decrease in complications, a 1.82% increase in mortality, a 3.22-day longer hospital length of stay, and a $5,270.840 increase in costs.
• In patients younger than 65 years, nonoperative management was associated with a 0.30% increase in complications, a 0.29% increase in mortality, a 2.81-day longer hospital length of stay, and a $4,334.81 increase in costs.

The findings highlight the need to conduct a randomized clinical trial of nonoperative vs operative management of appendicitis in older adults so that surgeons have relevant data to use when considering treatment options, the researchers say. Most prior clinical trials have studied younger adults, and this study shows that outcomes differ between younger and older adults.