Acute appendicitis in elderly patients as a non-trivial clinical problem

Introduction. At the present stage, the problem of providing specialized emergency surgical care to patients of older age groups is one of the urgent clinical tasks.

Results. The review analyzes from various positions a wide variety of factors of negative prognosis in acute appendicitis (AA) in an elderly cohort of patients. Epidemiological patterns of AA prevalence in elderly and senile individuals differ significantly from those in the younger population. Even without taking into account the undeniable factor of multimorbidity, older patients are characterized by later hospitalization, a wide variety of alternative urgent diagnoses, a higher frequency of AA complications and its treatment and, as a natural result, higher hospital mortality than among younger patients. Among the reasons for such patterns are: a wide incidence of atypical course of appendicitis, worse overall accuracy of modern clinical and laboratory diagnostic methods and a longer duration of preoperative diagnosis. In the global and Russian national paradigm of AA treatment, there is a key contradiction in the attitude towards non-surgical treatment of AA, and in its most acute form it is manifested in the example of elderly patients, for whom the frequency of appendectomy in Western countries is lower than for younger patients.

Conclusions. Diagnosis and treatment of AA in older people is a much more complex and technologically advanced process than in younger patients, which necessitates the need for surgeons to focus increased attention on this contingent of patients.

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