Early appendectomy improves survival in frail older adults

TOP LINE:

Older adults with uncomplicated acute appendicitis who underwent surgery within 1 day of admission were less likely to die in the hospital compared with those who were treated nonoperatively or had delayed surgery.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 24,320 older adults (mean age, 72 years; 50.9% women; 75.6% white) with uncomplicated appendicitis over a 2-year period beginning in 2016; of these, 7290 patients were frail.
• Patients received nonoperative treatment, immediate appendectomy within 1 day of admission, or deferred surgery more than 1 day after admission.
• Clinical outcomes included infectious complications by a composite method, cardiopulmonary complications, in-hospital mortality, length of hospital stay, and total hospital costs.
• Patient frailty was assessed using a claims-based index that produces a score ranging from 0 to 1 based on 93 variables.

CARRY:

• Patients with frailty had higher rates of infections (1.3% vs 0.4%), cardiopulmonary complications (24.1% vs 6.3%), overall complications (57.1% vs 28.8%), in-hospital deaths (3.9% vs 0.3%), longer hospital stays (6 vs 4 days), and higher hospital costs ($67,000 vs $42,000) than those without frailty (P
• Frail patients who underwent immediate surgery had a lower risk of death than those who received nonsurgical treatment (odds ratio (OR), 2.89; P = .004) and late surgery (OR, 3.80; P = .001).
• In non-frail patients, immediate surgery was associated with a higher risk of in-hospital complications than nonsurgical treatment (OR, 0.77; P = .009), but was associated with a lower risk than late appendectomy (OR, 2.05; P
• Black patients were less likely to receive an immediate appendectomy compared with white patients (P

IN PRACTICE:

“Our results suggest that the management of older adults with uncomplicated acute appendicitis may benefit from risk stratification based on the patient’s frailty status,” the authors wrote. “Routine frailty assessments should be incorporated into the care of older adult patients to guide shared decision-making discussions,” they added.

FOUNTAIN:

The study was led by Matthew Ashbrook, MD, MPH, of the Department of Surgery at the University of Southern California, Los Angeles, and published online August 26 in JAMA Network Open.

LIMITATIONS:

The modification of the frailty index and the reliance on discharge diagnosis could have led to misclassification bias. The timing of symptom presentation was not assessed. In addition, the lack of long-term data prevented the follow-up of readmissions and related complications.

DISCLOSURES:

The authors declared no conflicts of interest.

This article was created using a number of editorial tools, including artificial intelligence, as part of the process. Human editors reviewed this content before publication.