Appendicitis in the elderly

Aust N Z J Surg. 2000 Aug;70(8):593-6. doi: 10.1046/j.1440-1622.2000.01905.x.


Background: Acute appendicitis in the elderly (i.e. those over 60 years of age) is associated with high morbidity and mortality rates. The present retrospective study reviews 10 years ( 1986-1996) of experience and outcome in treating acute appendicitis in patients aged 60 or above.

Methods: One hundred and thirty patients with acute appendicitis were identified and their case notes reviewed.

Results: Acute appendicitis was diagnosed at admission in 84 patients (64.6%). The remaining patients were observed for a median duration of 9.4 h prior to diagnosis and treatment. Patients with an underlying perforated acute appendix had a significantly longer period of pain prior to admission (P = 0.029; Mann-Whitney U-test) but perforation per se was not associated with a significantly higher rate of morbidity and longer length of hospital stay. In contrast, the use of midline or paramedian incisions was associated with a higher wound infection rate (P=0.003; Pearson chi-squared test) and a longer hospital stay (P<0.001; Mann Whitney U-test). None of the patients were subsequently found to have an underlying colonic neoplasm. The overall morbidity rate was 28%. The mortality rate was 2.3% and all three patients who died had a severe comorbid medical condition prior to developing acute appendicitis.

Conclusions: Acute appendicitis in the elderly is still associated with significant morbidity. But once acute appendicitis is diagnosed, then expedient surgery, appropriate use of perioperative antibiotics and a right lower quadrant incision can help to minimize the morbidity. Pre-existing severe comorbid medical condition(s) is a major contributory factor to mortality in these patients.

MeSH terms

  • Abdominal Pain / etiology
  • Acute Disease
  • Aged*
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Appendectomy* / adverse effects
  • Appendectomy* / methods
  • Appendicitis / complications
  • Appendicitis / diagnosis*
  • Appendicitis / surgery*
  • Combined Modality Therapy
  • Comorbidity
  • Female
  • Humans
  • Intestinal Perforation / complications
  • Intestinal Perforation / diagnosis*
  • Intestinal Perforation / surgery*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Morbidity
  • Retrospective Studies
  • Rupture, Spontaneous
  • Surgical Wound Infection / etiology
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents