Use of the Alvarado score in elderly patients with complicated and uncomplicated appendicitis

Abstract

The purpose of this study was to determine whether the Alvarado score is beneficial in identifying complicated versus uncomplicated acute appendicitis in elderly patients. A retrospective review was conducted of patients aged 65 years and older who underwent an appendectomy for pathologically confirmed appendicitis. A review of 310 operative reports and patient charts from October 2012 to December 2016 yielded 216 patients. Patients were grouped based on complicated versus uncomplicated appendicitis. One hundred ten patients had complicated appendicitis, whereas 106 patients were uncomplicated. Among the complicated appendicitis patients, 76.4 per cent were perforated, 38.2 per cent were gangrenous, and 34.5 per cent had an abscess. The complicated appendicitis group had a higher mean duration of symptoms (2.70 6 3.41 days vs 2.09 6 3.08 days, P 5 0.011). Appendectomies that were open or converted to open were more likely to be associated with complicated appendicitis (75% vs 48%, P 5 0.012). Mean hospital length of stay was greater in those with complicated appendicitis (5.34 6 5.56 days vs 3.12 6 2.86 days, P < 0.001). The two groups did not differ on mean Alvarado score (complicated 5 6.96 6 1.99 vs uncomplicated 5 6.72 6 1.85, P 5 0.36). Only 62.5 per cent of patients had an Alvarado score that met the cutoff for acute appendicitis. The Alvarado score was not able to differentiate complicated from uncomplicated appendicitis in elderly patients.