老年人急性阑尾炎并发意外复杂阑尾炎。
Unexpected complicated appendicitis in the elderly diagnosed with acute appendicitis.
机构信息
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
出版信息
Am J Surg. 2019 Dec;218(6):1219-1222. doi: 10.1016/j.amjsurg.2019.08.013. Epub 2019 Aug 20.
BACKGROUND
This study determined the prevalence of complicated appendicitis in elderly patients diagnosed preoperatively with uncomplicated appendicitis.
METHODS
Patients with a preoperative diagnosis of uncomplicated appendicitis at an academic hospital from 11/2013 to 05/2017 were reviewed. Patients ≥65 years were compared to those younger. Pathology reports were categorized as either uncomplicated or complicated (COMP). The primary outcome was the prevalence of COMP appendicitis.
RESULTS
The prevalence of COMP appendicitis increased with age after 20 years with an abrupt increase after 65 years. Patients ≥65 years were more likely to have COMP appendicitis (48.1% vs. 15.5%; OR: 5.1; p < 0.01) and prolonged stays (3.8 vs. 2.3 days; p < 0.01).
CONCLUSION
Nearly half of elderly patients had pathologic confirmation of complicated appendicitis despite no preoperative clinical or radiographic suspicion for complicated appendicitis. Nonoperative management of acute appendicitis in the elderly may not be appropriate due to the high rate of unexpected complicated appendicitis.
背景
本研究旨在确定术前诊断为单纯性阑尾炎的老年患者中复杂阑尾炎的患病率。
方法
回顾 2013 年 11 月至 2017 年 5 月在一家学术医院术前诊断为单纯性阑尾炎的患者。将年龄≥65 岁的患者与年龄较轻的患者进行比较。病理报告分为单纯性或复杂性（COMP）。主要结局是 COMP 阑尾炎的患病率。
结果
20 岁后，随着年龄的增长，COMP 阑尾炎的患病率逐渐增加，65 岁后急剧增加。年龄≥65 岁的患者更有可能患有 COMP 阑尾炎（48.1%比 15.5%；OR：5.1；p<0.01）和住院时间延长（3.8 天比 2.3 天；p<0.01）。
结论
尽管术前临床或影像学检查没有提示复杂阑尾炎，但近一半的老年患者的病理检查证实存在复杂阑尾炎。由于意外复杂阑尾炎的发生率较高，老年患者的急性阑尾炎可能不适合非手术治疗。
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