Perioperative outcomes and appendiceal malignancy in elderly patients with acute appendicitis: a comparative retrospective cohort study.
- 1Department of General Surgery, Ufuk University Faculty of Medicine, Dr. Rıdvan Ege Hospital, Ankara, Türkiye. [email protected].
- 2Department of General Surgery, Ufuk University Faculty of Medicine, Dr. Rıdvan Ege Hospital, Ankara, Türkiye.
Abstract
Purpose
Acute appendicitis (AA) is increasingly diagnosed in elderly patients as life expectancy rises. Because elderly patients often present atypically and are prone to complications, we compared perioperative outcomes between patients younger than 65 and those aged 65 years and older.Methods
We included 488 patients who underwent appendectomy between January 2023 and January 2025, divided into Group 1 (18-64 years, n = 445) and Group 2 (≥ 65 years, n = 43). Demographics, comorbidities, symptoms, surgical characteristics, postoperative outcomes, and histopathology were compared. A multivariable logistic regression assessed whether age is an independent predictor of complications. Significance was set at p < 0.05.Results
Laparoscopic appendectomy (325 patients, 66.6%) was associated with shorter operative times, fewer complications, and shorter stays (all p < 0.05). Elderly patients more often presented with diffuse abdominal pain (25.6% vs. 8.1%, p < 0.001) and had higher complication rates (65.1% vs. 21.6%, p < 0.001), longer stays (p < 0.001), and higher readmission (18.6% vs. 2.2%, p < 0.001). Appendiceal malignancy was more frequent in the elderly (9.3% vs. 2.0%; p = 0.005). On multivariable analysis, advanced age was the strongest independent predictor of complications (adjusted OR 6.40; 95% CI 3.14-13.04; p < 0.001).Conclusions
Elderly patients with AA frequently present atypically, which may delay surgery and lead to more advanced disease. Advanced age was independently associated with higher perioperative morbidity. Given the significantly higher malignancy rate in the elderly (9.3% vs. 2.0%; p = 0.005), non-operative management may risk leaving life-threatening neoplasms undetected. However, given the small number of neoplasm cases (n = 4), these inferences are hypothesis-generating and should be interpreted cautiously.
Related
- Clinical, laboratory, operative, and appendiceal morphometric correlates of histopathological appendicitis severity: A retrospective cohort study from Palestine
- An Unsuspected Adult Intestinal Malrotation Presenting With Left-Sided Appendicitis, With the Diagnosis First Suggested by Purulent Drainage From the Appendiceal Orifice During an Elective Colonoscopy.
- Comparative perioperative and follow-up outcomes of three laparoscopic reconstructive procedures for pediatric duplex kidney : A retrospective cohort study
- Temporary Uterine Artery Clamping During Laparoscopic Myomectomy and Perioperative Hemoglobin Decline: A Retrospective Single-Center Comparative Study
- Comparative outcomes of fentanyl and morphine in critically ill patients with malignancy: a retrospective cohort study utilizing MIMIC-IV
BibTeX
@article{hazir2026perioperative,
title = {{Perioperative outcomes and appendiceal malignancy in elderly patients with acute appendicitis: a comparative retrospective cohort study.}},
author = {Baris Hazir and İgbal Osmanov and Gizem Aslan and Ugur Ekici},
journal = {Langenbeck's archives of surgery},
year = {2026},
month = aug,
doi = {10.1007/s00423-026-04163-7},
url = {https://europepmc.org/article/MED/42967968},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Perioperative outcomes and appendiceal malignancy in elderly patients with acute appendicitis: a comparative retrospective cohort study.
AU - Baris Hazir
AU - İgbal Osmanov
AU - Gizem Aslan
AU - Ugur Ekici
PY - 2026
DA - 2026/08/04
JO - Langenbeck's archives of surgery
DO - 10.1007/s00423-026-04163-7
UR - https://europepmc.org/article/MED/42967968
AB - Purpose Acute appendicitis (AA) is increasingly diagnosed in elderly patients as life expectancy rises. Because elderly patients often present atypically and are prone to complications, we compared perioperative outcomes between patients younger than 65 and those aged 65 years and older.Methods We included 488 patients who underwent appendectomy between January 2023 and January 2025, divided into Group 1 (18-64 years, n = 445) and Group 2 (≥ 65 years, n = 43). Demographics, comorbidities, symptoms, surgical characteristics, postoperative outcomes, and histopathology were compared. A multivariable logistic regression assessed whether age is an independent predictor of complications. Significance was set at p < 0.05.Results Laparoscopic appendectomy (325 patients, 66.6%) was associated with shorter operative times, fewer complications, and shorter stays (all p < 0.05). Elderly patients more often presented with diffuse abdominal pain (25.6% vs. 8.1%, p < 0.001) and had higher complication rates (65.1% vs. 21.6%, p < 0.001), longer stays (p < 0.001), and higher readmission (18.6% vs. 2.2%, p < 0.001). Appendiceal malignancy was more frequent in the elderly (9.3% vs. 2.0%; p = 0.005). On multivariable analysis, advanced age was the strongest independent predictor of complications (adjusted OR 6.40; 95% CI 3.14-13.04; p < 0.001).Conclusions Elderly patients with AA frequently present atypically, which may delay surgery and lead to more advanced disease. Advanced age was independently associated with higher perioperative morbidity. Given the significantly higher malignancy rate in the elderly (9.3% vs. 2.0%; p = 0.005), non-operative management may risk leaving life-threatening neoplasms undetected. However, given the small number of neoplasm cases (n = 4), these inferences are hypothesis-generating and should be interpreted cautiously.
SN - 1435-2443
SN - 1435-2451
ER -