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.
OBJECTIVE: 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.
OBJECTIVE: 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.
摘要：
背景：阑尾炎是全球最常见的腹部外科急症。人口老龄化,经常表现出非典型症状和延迟表现，挑战传统的诊断和治疗范式。
目的：本研究旨在描述演示中的差异，管理,以及患有急性阑尾炎的老年患者和年轻成人之间的结果。
方法：此亚组分析是ESTESSnapAppy的一部分，一个有时间限制的多中心预期，观察性队列研究。它包括在多个中心定义的90天观察期内接受腹腔镜阑尾切除术的15岁及以上患者。使用适当的检验进行统计学比较,显著性设定为p<0.05。
结果：研究队列包括521名老年患者（≥65岁）和4,092名年轻成年人（18-64岁）。老年患者就诊较晚（平均症状持续时间：7.88vs.3.56天；p<0.001）和经常需要的计算机断层扫描（CT）扫描进行诊断（86.1％vs.54.0%；p<0.001)。老年人并发阑尾炎的发病率较高(46.7%vs.20.7%；p<0.001)。老年人的手术干预延迟明显（24小时内手术的比例为85.0％，88.7%；p=0.018)，手术时间较长(71.1vs.60.3分钟；p<0.001)。老年人术后并发症明显高于老年人（27.9%vs.12.9%；p<0.001)，包括严重并发症（6.9%vs.2.4%；p<0.001）和住院时间延长（7.9vs.3.6天；p<0.001)。
结论：我们的研究结果强调了与年轻患者相比，老年人急性阑尾炎的临床病程和结局存在显著差异。提示需要适应年龄的诊断途径和治疗策略,以改善这一脆弱人群的结局.
目的：本研究旨在描述演示中的差异，管理,以及患有急性阑尾炎的老年患者和年轻成人之间的结果。
方法：此亚组分析是ESTESSnapAppy的一部分，一个有时间限制的多中心预期，观察性队列研究。它包括在多个中心定义的90天观察期内接受腹腔镜阑尾切除术的15岁及以上患者。使用适当的检验进行统计学比较,显著性设定为p<0.05。
结果：研究队列包括521名老年患者（≥65岁）和4,092名年轻成年人（18-64岁）。老年患者就诊较晚（平均症状持续时间：7.88vs.3.56天；p<0.001）和经常需要的计算机断层扫描（CT）扫描进行诊断（86.1％vs.54.0%；p<0.001)。老年人并发阑尾炎的发病率较高(46.7%vs.20.7%；p<0.001)。老年人的手术干预延迟明显（24小时内手术的比例为85.0％，88.7%；p=0.018)，手术时间较长(71.1vs.60.3分钟；p<0.001)。老年人术后并发症明显高于老年人（27.9%vs.12.9%；p<0.001)，包括严重并发症（6.9%vs.2.4%；p<0.001）和住院时间延长（7.9vs.3.6天；p<0.001)。
结论：我们的研究结果强调了与年轻患者相比，老年人急性阑尾炎的临床病程和结局存在显著差异。提示需要适应年龄的诊断途径和治疗策略,以改善这一脆弱人群的结局.
