Min LQ, Lu J, He HY. Clinical significance of appendicoliths in elderly patients over eighty years old undergoing emergency appendectomy: A single-center retrospective study. World J Gastrointest Surg 2024; 16(11): 3453-3462 [DOI: 10.4240/wjgs.v16.i11.3453]
Corresponding Author of This Article
Hong-Yong He, MD, PhD, Associate Chief Physician, Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. he.hongyong@zs-hospital.sh.cn
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Nov 27, 2024; 16(11): 3453-3462 Published online Nov 27, 2024. doi: 10.4240/wjgs.v16.i11.3453
Clinical significance of appendicoliths in elderly patients over eighty years old undergoing emergency appendectomy: A single-center retrospective study
Ling-Qiang Min, Jing Lu, Hong-Yong He
Ling-Qiang Min, Hong-Yong He, Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jing Lu, Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Co-first authors: Ling-Qiang Min and Jing Lu.
Author contributions: Min LQ and Lu J collected and analyzed the data, and wrote the manuscript; He HY designed the study and edited the manuscript; Min LQ and Lu J contributed equally to this work; all authors have read and approved the final manuscript.
Supported bythe National Natural Science Foundation of China, No. 82373417; Natural Science Foundation of Shanghai, No. 23ZR1409900; and Clinical Research Fund of Zhongshan Hospital, Fudan University, No. ZSLCYJ202343.
Institutional review board statement: This study was approved by the Clinical Research Ethics Committee of Zhongshan Hospital of Fudan University (No. B2024-321).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Yong He, MD, PhD, Associate Chief Physician, Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. he.hongyong@zs-hospital.sh.cn
Received: June 13, 2024 Revised: August 29, 2024 Accepted: September 12, 2024 Published online: November 27, 2024 Processing time: 138 Days and 16.9 Hours
Abstract
BACKGROUND
Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation.
AIM
To analyze the clinical data of elderly patients undergoing emergency appendectomy for acute appendicitis, aiming to improve treatment strategies.
METHODS
The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital, Fudan University from January 2016 to March 2023 were retrospectively analyzed. The patients were divided into two groups based on the presence of an appendicolith or not, and clinicopathological and surgery-related features were compared between the two groups.
RESULTS
The duration of abdominal pain in all 122 patients ranged from 5 to 168 h. All patients underwent emergency appendectomy: 6 had an open appendectomy, 101 had a laparoscopic appendectomy, and 15 required conversion from laparoscopic to open surgery, resulting in a conversion rate of 12.9% (15/116). The patients were divided into two groups: Appendicolith group (n = 46) and non-appendicolith group (n = 76). Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene (84.8% vs 64.5%, P = 0.010) and perforation (67.4% vs 48.7%, P = 0.044), and had a lower surgical conversion rate (2.2% vs 19.7%, P = 0.013). The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them. All patients were successfully discharged.
CONCLUSION
Around 40% of patients over 80 years old with acute appendicitis have an appendicolith, increasing their risk of developing appendiceal gangrene and perforation, and therefore should receive timely surgical treatment.
Core Tip: Acute appendicitis is increasingly a common cause of abdominal pain among elderly patients in China. Although antibiotic therapy has become the primary treatment for acute uncomplicated appendicitis, elderly patients experience significantly higher rates of postoperative complications. Our study revealed that about 40% of these elderly patients had an appendicolith, which put them at a higher risk for appendiceal gangrene and perforation. This finding emphasizes the necessity for timely surgical intervention in these cases.
