What have we learned over the past 20 years about appendicitis in the elderly?

Background: This study evaluates appendicitis in the elderly, comparing our findings to those previously published a decade earlier. Methods: Comparison of appendicitis in the elderly (aged 60 years and older) from 1978 to 1988 with the following 10 years, 1988 to 1998. Results: Overall (1978-1998) 26% of patients presented typically, one third delayed seeking care, with only half diagnosed correctly on admission. Computed tomograhy (CT) use increased (44% versus rarely in the previous decade). Perforation rates declined (72% first group versus 51% second group) with a concomitant drop in complications from 32% to 21% respectively. Overall, three fourths of complications occurred in patients with perforated appendicitis. Mortality rates remained constant. Conclusions: Appendicitis in the elderly is a difficult problem with delays in medical care, nontypical presentation resulting in incorrect diagnosis, relatively high rates of perforation often with associated postoperative complications and mortality. A higher index of suspicion with liberal early utilization of CT in uncertain cases may result in more appropriate management. (C) 2003 Excerpta Medica Inc. All rights reserved.