Fransvea Pietro, Chiarello Maria Michela, Fico Valeria, Cariati Maria, Brisinda Giuseppe
Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy.
Department of Surgery, Provincial Health Authority, Cosenza 87100, Italy.
World J Clin Cases. 2024 Nov 26;12(33):6580-6586. doi: 10.12998/wjcc.v12.i33.6580.
In developed countries, the average life expectancy has been increasing and is now well over 80 years. Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups. Acute appendicitis is one of the most common surgical diseases, with a lifetime risk of 8%. A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups (> 80 years). Among patients > 50-year-old who present to the emergency department for acute abdominal pain, 15% have acute appendicitis. In these patients, emergency surgery for acute appendicitis is challenging, and some important aspects must be considered. In the elderly, surgical treatment outcomes are influenced by sarcopenia. Sarcopenia must be considered a precursor of frailty, a risk factor for physical function decline. Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity. Aside from morbidity and mortality, the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance. Therefore, prediction of function decline is critical. In emergency surgery, preoperative interventions are difficult to implement because of the narrow time window before surgery. In this editorial, we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.
在发达国家，平均预期寿命一直在增加，目前已远超过80岁。预期寿命的增加与老年人群体中急诊手术数量的增加有关。急性阑尾炎是最常见的外科疾病之一，终生患病风险为8%。老年人群体以及年龄最大的群体（>80岁）中急性阑尾炎的发病率一直在上升。在因急性腹痛到急诊科就诊的50岁以上患者中，15%患有急性阑尾炎。对于这些患者，急性阑尾炎的急诊手术具有挑战性，必须考虑一些重要方面。在老年人中，手术治疗结果受肌肉减少症影响。肌肉减少症必须被视为虚弱的先兆，是身体功能下降的危险因素。肌肉减少症对择期手术和急诊手术的死亡率和发病率均有负面影响。除了发病率和死亡率外，需要急诊手术的老年患者最重要的结果是减少功能下降和维持术前身体功能。因此，预测功能下降至关重要。在急诊手术中，由于术前时间窗口狭窄，术前干预难以实施。在这篇社论中，我们强调老年患者急性阑尾炎的独特方面以及肌肉减少症和虚弱对手术治疗结果的影响。
