# Safety of In‐Hospital Delay of Appendectomy in Elderly Patients—A Retrospective Analysis of 525 Consecutive Patients Aged 65 and Older Undergoing Surgery for Suspected Appendicitis

## TL;DR

The study finds that delaying appendectomy surgery for 12 hours in elderly patients does not increase the risk of complications or perforation.

## Contribution

This is the first large retrospective analysis demonstrating the safety of delaying appendectomy in patients aged 65 and older.

## Key findings

- Delaying surgery for more than 12 hours was not associated with increased perforation or complication rates in elderly patients.
- Elevated CRP levels and suspected perforation on imaging were significant risk factors for complications and perforation.

## Abstract

Recent retrospective and prospective studies have demonstrated the safety of delayed surgery for acute appendicitis. However, evidence regarding delayed surgery in elderly patients is limited, and it is unclear whether it is safe to delay appendectomy in this patient population.

The outcomes of patients aged 65 years and older who underwent appendectomy for suspected appendicitis at a single institution were reviewed and analyzed. The outcomes investigated were perforation rate and complication rate. Multivariable logistic regression analysis was performed to adjust for risk factors and calculate adjusted odds ratios (aOR) for in‐hospital delay.

A total of 525 patients aged 65 years and older underwent appendectomy for suspected appendicitis. The perforation rate was 44.4% (233 of 525) and the complication rate was 25.1%. The multivariable analysis showed no association between a waiting time of more than 12 h compared to less than 12 h and perforation rate (aOR 0.96; 95% CI 0.55–1.70; p = 0.90) or complication rate (aOR 0.93; 95% CI 0.49–1.76; p = 0.83). A risk factor for perforation in the multivariable analysis was an elevated CRP level ≥ 50 mg/L and risk factors for complications were suspected perforation on preoperative imaging (p = 0.004), anticoagulant use (p = 0.04), and CRP levels ≥ 150 mg/L (p < 0.001).

This large retrospective analysis showed that it is safe to delay surgery by 12 h in patients aged 65 years and older. Delayed surgery was not associated with a higher rate of perforation or complications after adjusting for risk factors. These results open the possibility of optimizing coagulation or possible comorbidities in elderly patients before surgery or postponing surgery when more critical cases require more urgent treatment. In patients with suspected perforation on imaging, the decision to delay surgery should me made with caution, taking into account the patient's overall presentation, comorbidities, and vital signs.

Recent retrospective and prospective studies have demonstrated the safety of delayed surgery for acute appendicitis. However, evidence regarding delayed surgery in elderly patients is limited, and it is unclear whether it is safe to delay appendectomy in this patient population.