The risks of failed nonoperative management of appendicitis in older adults.

Background: The consequences of failed nonoperative management of appendicitis in older patients have not been described.

Methods: We used the 2004-2017 National Inpatient Sample to identify acute appendicitis patients managed nonoperatively (<65 years old: 32,469; ≥65 years old: 11,265). Outcomes included morbidity, length of stay (LOS), inpatient costs, and discharge to skilled facilities. Differences were estimated using propensity scores.

Results: For patients <65, nonoperative failure was associated with increased morbidity (7 ​% [95 ​% CI 6.9 ​%-8.1 ​%]), LOS (3 day [95 ​% CI 3-4]), costs ($9015 [95 ​% CI $8216- $9446]), and discharges to skilled facilities (1 ​% [95 ​% CI 0.9 ​%-1.6 ​%]) compared to successful nonoperative treatment. Patients ≥65 had differences in morbidity (14 ​% [95 ​% CI 13.6 ​%-16.2 ​%]), LOS (6 days [95 ​% CI 5-6]), costs ($15,964 [95 ​% CI $15,181- $17,708]), and discharges to skilled facilities (12 ​% [95 ​% CI: 10.0 ​%-13.3]) compared to nonoperative success.

Conclusions: Nonoperative management of appendicitis should be approached cautiously for older adults.