Benefits, harms of surgery vary according to age in adults with appendicitis

Nonoperative outcomes for acute appendicitis differ by age of the patient, according to a study published online April 5 in JAMA Surgery.

Jennie Meier, M.D., M.P.H., from the University of Texas Southwestern in Dallas, and colleagues compared outcomes for nonoperative versus operative management of acute appendicitis in older adults and younger adults. Analysis included data from 43,846 who were treated nonoperatively and 430,999 with appendectomy (2004 to 2017).

The researchers found that among patients aged 65 years and older, nonoperative management was associated with a 3.72 percent decrease in risk of complications and a 1.82 percent increase in mortality. Nonoperative management was also associated with increased length of hospitalization and costs. However, in patients under 65 years, outcomes were significantly different than in older adults. In younger patients, there were only minor differences seen between nonoperative and operative management with respect to morbidity and mortality and smaller differences in length of hospitalization and costs.

"Nonoperative outcomes in this study were different in older versus younger adults with acute appendicitis," the authors write. "This highlights the need to conduct a comprehensive randomized clinical trial of nonoperative versus operative management of appendicitis in older adults so that surgeons have relevant data to use when considering treatment options."

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