Upfront Appendectomy Improves Survival Among Frail Older Adults

TOPLINE:
Older adults with acute uncomplicated appendicitis who were operated on within 1 day of admission were less likely to die in the hospital compared with those who were treated with nonsurgical management or who had a delayed surgery.
METHODOLOGY:
Researchers conducted a retrospective cohort study of 24,320 older adults (median age, 72 years; 50.9% women; 75.6% White) with uncomplicated appendicitis over a 2-year period starting in 2016; of these, 7290 patients were frail.
Patients received nonsurgical treatment, immediate appendectomy within 1 day of admission, or delayed surgery after more than 1 day of admission.
The clinical outcomes included infectious complications using a composite, cardiopulmonary complications, in-hospital mortality, length of hospital stay, and total hospital costs.
Frailty of patients was assessed using a claims-based index producing a score ranging from 0 to 1 on the basis of 93 variables.
TAKEAWAY:
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 < .001).
Patients with frailty who had immediate surgery had lower risk for death than those who received nonsurgical treatment (odds ratio [OR], 2.89; P = .004) and delayed surgery (OR, 3.80; P = .001).
In patients without frailty, immediate surgery was linked to a higher risk for hospital complications than nonsurgical treatment (OR, 0.77; P = .009), but it was linked to a lower risk than delayed appendectomy (OR, 2.05; P < .001).
Black patients were less likely to receive immediate appendectomy compared with White patients (P < .001).
IN PRACTICE:
“Our results suggest that treatment of older adults with acute uncomplicated appendicitis may benefit from risk stratification based on patient frailty status,” the authors wrote. “Routine frailty assessments should be incorporated in the care of older adult patients to guide discussions for shared decision-making,” they added.
SOURCE:
The study was led by Matthew Ashbrook, MD, MPH, of the Department of Surgery, University of Southern California, Los Angeles, and published online on August 26 in JAMA Network Open.
LIMITATIONS:
Modification of the frailty index and reliance on discharge diagnosis could have resulted in misclassification bias. The timing of presentation of symptoms was not assessed. Also, lack of long-term data prevented tracking of readmissions and related complications.
DISCLOSURES:
The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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