OUTCOME OF APPENDICITIS IN THE ELDERLY IN UNIVERSITAS AND PELONOMI HOSPITALS.

BACKGROUND: In the elderly population, appendicitis still poses a high mortality and morbidity. Morbidity rates of 28-60% and mortality rates of 5-10% have been reported. The mortality rate is even higher in the presence of perforated appendicitis. Various factors have been pointed out to contribute to this trend.

METHOD: A retrospective analytical study on all patients over the age of 60 years who had appendectomies at Universitas or Pelonomi Hospital between 01 January 2004 and 31 December 2014 was done. Data of all appendectomy specimens received at Anatomical Pathology was collected and the hospital numbers were retrieved. The patients' clinical records were then scrutinised and the data transferred to an Excel spread sheet. The data was analysed using the Fisher two-tailed test and a p-value of < 0.05 was considered significant. Ethic clearance was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences (ECUFS 57/2015).

RESULTS: Sixty-eight elderly patients aged 60 years and older were identified over a period of 10 years. Only 47 patients met the inclusion criteria. Mean age was 67.2 years with male:female ratio of 1:1.2. The average delay to presentation was 3 days. The correct diagnosis was made in 26 (53%) patients. Preoperative imaging was done in four patients (8.5%). Fortytwo patients (89.4%) had a simple appendectomy, while 5 (10.6%) had a right-hemicolectomy. Average length of stay (LOS) was six days, while the LOS for perforated appendicitis was 17 days. Ten patients died in hospital, resulting in an inhospital mortality rate of 21%. Eight of these had perforated appendicitis. Twenty-three patients (51.1%) had perforation, 22 (48.9%) did not, while in two this finding was not recorded. Twenty-five patients (53.2%) had complications. Re-look laparotomies happened in 12 (25.5%) patients.

CONCLUSION: Morbidity and mortality are indeed still high in the elderly population. The incidence of re-look laparotomy is high in our institution and this is associated with a higher mortality. If the LOS is corrected, our figures are on par with other institutions. Late presentation and wrong initial diagnosis remain a stumbling block in the management of the elderly patient with appendicitis.