Emergency Surgery and Trauma-Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
Surgery Center, Campus Bio-Medico University Hospital, University Campus Bio-Medico of Rome, Rome, Italy.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1177-1188. doi: 10.1007/s00068-021-01645-9. Epub 2021 Mar 18.
Emergency abdominal surgery in the elderly represents a global issue. Diagnosis of AA in old patients is often more difficult. Appendectomy remains the gold standard of treatment and, even though it is performed almost exclusively with a minimally invasive technique, it can still represent a great risk for the elderly patient, especially above 80 years of age. A careful selection of elderly patients to be directed to surgery is, therefore, fundamental. The primary aim was to critically appraise and compare the clinical-pathological characteristics and the outcomes between oldest old (≥ 80 years) and elderly (65-79 years) patients with Acute Appendicitis (AA).
The FRAILESEL is a large, nationwide, multicentre, prospective study investigating the perioperative outcomes of patients aged ≥ 65 years who underwent emergency abdominal surgery. Particular focus has been directed to the clinical and biochemical presentation as well as to the need for operative procedures, type of surgical approach, morbidity and mortality, and in-hospital length of stay. Two multivariate logistic regression analyses were performed to assess perioperative risk factors for morbidity and mortality.
182 patients fulfilled the inclusion criteria. Mean age, ileocecal resection, OAD and ASA score ≥ 3 were related with both overall and major complication. The multivariate analysis showed that MPI and complicated appendicitis were independent factors associated with overall complications. OAD and ASA scores ≥ 3 were independent factors for both overall and major complications.
Age ≥ 80 years is not an independent risk factor for morbidities. POCUS is safe and effective for the diagnosis; however, a CECT is often needed. Having the oldest old a smaller functional organ reserve, an earlier intervention should be considered especially because they often show a delay in presentation and frequently exhibit a complicated appendicitis.
老年人的急诊腹部手术是一个全球性问题。老年患者的 AA 诊断通常更为困难。阑尾切除术仍然是治疗的金标准，尽管它几乎完全采用微创技术进行，但对 80 岁以上的老年患者仍然存在很大的风险。因此，仔细选择需要手术的老年患者至关重要。主要目的是批判性地评估和比较最年长（≥80 岁）和老年（65-79 岁）急性阑尾炎（AA）患者的临床-病理特征和结局。
FRAILESEL 是一项大型的全国性多中心前瞻性研究，调查了接受急诊腹部手术的年龄≥65 岁患者的围手术期结局。特别关注了临床和生化表现以及手术程序、手术方式、发病率和死亡率以及住院时间的需求。进行了两次多变量逻辑回归分析，以评估发病率和死亡率的围手术期危险因素。
182 名患者符合纳入标准。平均年龄、回盲部切除术、OAD 和 ASA 评分≥3 与总并发症和主要并发症相关。多变量分析显示，MPI 和复杂阑尾炎是与总并发症相关的独立因素。OAD 和 ASA 评分≥3 是总并发症和主要并发症的独立因素。
年龄≥80 岁不是发病率的独立危险因素。POCUS 安全有效，可用于诊断，但通常需要 CECT。由于最年长的老年人器官功能储备较小，应更早考虑干预措施，尤其是因为他们通常会出现就诊延迟，并且经常表现出复杂的阑尾炎。
