A. Deiters1, A. Drozd1, P. Parikh1, R. Markert1, J. K. Shim1 1Wright State University,Dayton, OH, USA
Introduction: With increasing life expectancy, elderly patients experience a higher incidence of diseases previously associated with the younger population. With an incidence of acute appendicitis in this age group of approximately 9.3%, high rates of perforated and gangrenous appendicitis have been reported. The purpose of this study was to determine whether the Alvarado Score is beneficial in identifying complicated versus uncomplicated acute appendicitis in elderly patients. Early diagnosis of patients with complications from acute appendicitis would lead to early treatment.
Methods: We conducted a retrospective review of patients 65 years and older who underwent an appendectomy for pathologically confirmed appendicitis. Patient data were collected from five local hospitals within one healthcare network. A review of 310 operative reports and patient charts from October 1, 2012 – December 31, 2016 yielded 216 patients who qualified for the study. Patients were grouped based on complicated (perforated or gangrenous or abscessed) versus uncomplicated appendicitis. An Alvarado Score is calculated from 8 sub-scores – signs, symptoms, and lab values (e.g., RLQ tenderness, leukocytosis >10,000). Eighty-six patients had complete data, and 130 patients had one or more missing sub-score. Multiple imputation was used to replace all missing sub-scores (12% of values).
Results: The 110 of 216 patients (51%) with complicated appendicitis had a mean age of 72.9 years, while the 106 uncomplicated patients (49%) had a mean age of 73 (p=0.97), and the two groups did not differ significantly on mean duration of symptoms (complicated = 2.70 days vs. uncomplicated = 2.09 days; p=0.17). Among the 110 complicated patients 76% had perforated appendicitis, 38% were gangrenous, and 35% had an abscess.
The mean Alvarado Score of the two groups did not differ (complicated = 6.86 vs. uncomplicated = 6.58, p=0.32). An Alvarado Score of 7 or higher indicates acute appendicitis. Within the complicated group, patients ≥76 years old were similar to those ≤75 years in proportion with an Alvarado Score ≥7 (≥76 years = 54% vs. ≤75 years = 53%, p=0.93). However, within the uncomplicated group, younger patients were more likely than older patients to have an Alvarado Score ≥7 (≥76 years = 28% vs. ≤75 years = 54%, p=0.02). The complicated group was more likely to have postoperative complications (41% vs. 25%, p=0.012). Mean hospital length of stay was greater in those with complicated appendicitis compared to uncomplicated (5.34 days vs. 3.12 days, p<0.001).
Conclusion: We found that the Alvarado Score did not differentiate complicated from uncomplicated appendicitis in elderly patients. The scoring system also did not provide an accurate diagnosis of acute appendicitis in approximately half our patient population. Future studies should investigate why a high percentage of elderly patients present initially with complicated appendicitis.