Risk factors associated with perforated acute appendicitis in geriatric emergency patients

OBJECTIVE: The aim of this study was to identify factors associated with perforated acute appendicitis in geriatric patients at the emergency department (ED). PATIENTS AND METHODS: The medical records of 223 consecutive patients aged >60 years with acute appendicitis between 2006 and 2017 were retrospectively reviewed. Patients were grouped into those with perforated and non-perforated appendicitis. A comparison was made between the two groups in regard to baseline characteristics, clinical presentation, physical examination, time from onset of symptoms to ED arrival, time from ED arrival to operation, postoperative complications, hospital length of stay, and mortality. Significant factors associated with perforated appendicitis were examined using univariate and multivariate analyses by logistic regression. RESULTS: A total of 78 (35%) patients had perforated appendicitis. Four significant factors associated with perforated appendicitis were as follows: 1) time duration from onset of symptoms to ED arrival >24 hours (OR 2.49, CI 1.33–4.68); 2) heart rate ≥90 beats/minute (OR 1.93, CI 1.04–3.59); 3) respiratory rate ≥20 breaths/minute (OR 2.54, CI 1.33–4.84); and 4) generalized guarding (OR 12.58, CI 1.43–110.85). CONCLUSION: Time duration from onset of symptoms to ED arrival >24 hours, heart rate ≥90 beats/minute, respiratory rate ≥20 breaths/minute, and generalized guarding were the significant factors associated with perforated acute appendicitis in geriatric patients.