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.
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.