Elli yaþ üstü hastalarda akut apandisit: Klinik deðiþkenlerin ameliyat ve ameliyat sonrasý sonuçlara etkisinin deðerlendirilmesi

AMAÇ: Elli yaþ üzerindeki akut apandisit hastalarýnda yapýlan çalýþmalarda daha yüksek mortalite, daha yüksek perforasyon oranlarý, semptom baþlangýcýndan hastaneye yatýþa kadar daha fazla gecikme, daha yüksek komplikasyon oranlarý ve histopatolojik incelemelerde daha yüksek malignite sonuçlarý bildirilmiþtir. Bu çalýþmada, akut apandisit tanýsý alan ve bu taný nedeniyle ameliyat edilen 50 yaþ ve üzeri bir hasta popülasyonunda ameliyat ve ameliyat sonrasý bulgularý etkileyebilecek klinik, laboratuvar ve görüntüleme bulgularýnýn aydýnlatýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya, Ocak 2017 ile Ocak 2020 arasýnda akut apandisit nedeniyle tek bir üçüncü basamak hastanede ameliyat edilen 50 yaþ ve üzerindeki tüm hastalar alýndý. Hastalarýn demografik verileri, komorbiditeleri, laboratuvar ve görüntüleme bulgularý, ame-liyat ve ameliyat sonrasý sonuçlarý, hastalarda geliþen cerrahi komplikasyonlar ve alýnan örneklerin histopatolojik deðerlendirmeleri detaylý olarak incelendi.
BULGULAR: Ortanca yaþý 59 olan, acil apendektomi yapýlan 50 yaþ ve üzerinde toplam 152 hasta çalýþmaya alýndý. Ameliyat öncesi iki ya da daha fazla konorbidite varlýðýnýn ve ameliyat sonrasý yoðun bakým ünitesinde (YBÜ) yatýþ süresinin cerrahi komplikasyonlarýn geliþimiyle anlamlý derecede iliþkili olduðu gösterildi (sýrasýyla, p=0.002 ve p=0.006). Cerrahi komplikasyon geliþen hastalarda toplam yatýþ süresinin daha uzun (p<0.001), ameliyat öncesi albümin düzeylerinin daha düþük (p=0.017) ve takipte YBÜ’de yatýþ süresinin daha yüksek (p=0.006) olduðu görüldü. Açýk apendektomi yapýlan hastalarda ameliyat öncesi lökosit düzeylerinin daha yüksek olduðu görüldü (p=0.047). Ameliyat öncesi karýn aðrýsý süresinin hastanede yatýþ süresi ile güçlü bir þekilde iliþkili olduðu gözlendi (p<0.001). Ayrýca hastalarýn hastanede yatýþ süreleri ile ameliyat öncesi C-reaktif protein düzeyleri arasýnda güçlü bir korelasyon saptandý (p<0.001).
TARTIÞMA: Akut apandisitin geç eriþkinlerde yönetiminin taný ve ameliyat sonrasý süreçler açýsýndan zorlu olduðu öne sürülmüþtür. Bu nedenle, bu hastalara ait ameliyat öncesi klinik, laboratuvar ve görüntüleme verileri dikkatli ve titizlikle deðerlendirilmelidir.

Acute appendicitis over the age of 50: The evaluation of the impact of clinical variables on operative and post-operative outcomes

BACKGROUND: Studies reported higher mortality and perforation rates, marked increase in delay from symptom onset to hospital admission, significant complication rates, as well as excessive malignancy outcomes on histopathological examinations in patients older than 50 years of age with acute appendicitis. Herein, it was aimed to reveal the clinical, laboratory, and imaging findings that might affect the operative and post-operative findings in a population of patients over the age of 50 who were diagnosed with and operated for acute appendicitis.
METHODS: Patients who were older than 50 years of age and operated for the diagnosis acute appendicitis between January 2017 and January 2020 in a single tertiary hospital were included in this retrospective study. Demographic data, comorbidities, laboratory and imaging findings, operative and post-operative results, surgical complications, as well as the histopathological evaluation of the excised materials of all patients were analyzed in detail.
RESULTS: A total of 152 patients who were older than 50 years of age and who underwent emergent appendectomy with a median age of 59 were included in the study. It was demonstrated that the development of surgical complications was significantly associated with post-operative hospitalization at the intensive care unit (ICU) and the presence of 2 or more comorbidities preoperatively (p=0.006 and p=0.002, respectively). It was observed that the duration of total hospitalization was longer (p<0.001), pre-operative al-bumin levels were lower (p=0.017), and the rate of hospitalization at ICU during the follow-up period was higher (p=0.006) in patients with surgical complications. Pre-operative white blood cell counts appeared to be significantly increases in patients who had open appendectomy (p=0.047). Moreover, both the duration of pre-operative abdominal pain and pre-operative C-reactive protein levels was found to significantly correlate with the duration of hospitalization (p<0.001 and p<0.001, respectively).
CONCLUSION: The management of acute appendicitis in late adulthood was suggested to be challenging both in terms of diagnosis and post-operative processes. Therefore, pre-operative clinical, laboratory, and imaging data obtained from these patients should be carefully and elaborately evaluated.