Introduction: Appendectomy for acute appendicitis is the most common general surgical emergency procedure. Acute appendicitis is generally considered a disease of youth. The incidence of AA is thought to be highest in the second and third decade of life. As the proportion of older patients increases, the number of elderly patients with AA is likely to increase. The effect of an aging population on the demographics and utilization of resources related to acute appendicitis is unknown. We evaluated the statewide experience with acute appendicitis in elderly patients to assess the effect of this common disease on health care resources.

Methods: A state database was queried for all patients with acute appendicitis by ICD-9-CM codes (540-541) for 2007. Subjects admitted to rehabilitation hospitals, patients transferred to a second facility, patients with inflammatory bowel disease, or those undergoing incidental appendectomy were excluded. Procedures were defined as open appendectomy, laparoscopic appendectomy or complicated open procedures (colectomy, abcess drain). Data are presented as the mean + SD.

Results: Young patients (< 29 years) comprised 45% of subjects with appendicitis which was the same proportion as middle aged patients (30-64 years) (Table). Total hospital charges increased significantly with increasing age of patients with appendicitis and the youngest patients accounted for only 37.6% of all charges (Table). Elderly patients (> 65 years) comprised 9.3% of all appendicitis patients but accounted for 14.2% of health care charges related to acute appendicitis. While the proportion of laparoscopic appendectomy was high in all age groups, length of stay and percentage of complicated procedures significantly increased with age (Table).

Conclusion: Acute appendicitis is no longer strictly a disease of the young. Older patients with acute appendicitis represent a substantial proportion of cases and a disproportionate share of health care resources related to acute appendicitis. Acute appendicitis as a cause of abdominal pain or abdominal symptoms should be considered as a potential etiology for patients of all age groups.