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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2021

01-07-2021 | Antibiotic | Guidelines

EAES rapid guideline: appendicitis in the elderly

Authors: Stavros A. Antoniou, Dimitris Mavridis, Katerina Maria Kontouli, Vasileios Drakopoulos, Marguerite Gorter-Stam, Sture Eriksson, Marc Leone, Maria Carmen Pérez-Bocanegra, Neil J. Smart, Marco Milone, Francesco Maria Carrano, George A. Antoniou, Per Olav Vandvik

Published in: Surgical Endoscopy | Issue 7/2021

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Abstract

Background

There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients.

Methods

We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

Results

This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://​app.​magicapp.​org/​#/​guideline/​4494.

Conclusions

This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.
Appendix
Available only for authorised users
Literature
1.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925CrossRef
2.
Naar L, Kim P, Byerly S, Vasileiou G, Zhang H, Yeh DD et al (2020) Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: a post hoc analysis of an EAST multicenter study. Surgery 168(4):701–706CrossRef
3.
Mohamed I, Chan S, Bhangu A, Karandikar S (2019) Appendicitis as a manifestation of colon cancer: should we image the colon after appendicectomy in patients over the age of 40 years? Int J Colorectal Dis 34(3):527–531CrossRef
4.
Etkind SN, Bone AE, Lovell N, Higginson IJ, Murtagh FEM (2018) Influences on care preferences of older people with advanced Illness: a systematic review and thematic synthesis. J Am Geriatr Soc 66(5):1031–1039CrossRef
5.
6.
7.
8.
9.
Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G et al (2011) GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 64(4):395–400CrossRef
10.
Hultcrantz M, Rind D, Akl EA, Treweek S, Mustafa RA, Iorio A et al (2017) The GRADE working group clarifies the construct of certainty of evidence. J Clin Epidemiol 87:4–13CrossRef
11.
12.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898CrossRef
13.
Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919CrossRef
14.
15.
Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M et al (2016) GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: clinical practice guidelines. BMJ 353:i2089CrossRef
16.
Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines (2011). In: Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E (eds) Clinical practice guidelines we can trust. National Academies Press, Washington (PMID: 24983061)
17.
Qaseem A, Forland F, Macbeth F, Ollenschläger G, Phillips S, van der Wees P et al (2012) Guidelines international network: toward international standards for clinical practice guidelines. Ann Intern Med 156(7):525–531CrossRef
18.
Liu W, Wei Qiang J, Xun Sun R (2015) Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis. J Int Med Res 43(3):341–349CrossRef
19.
Moazzez A, Mason RJ, Katkhouda N (2013) Thirty-day outcomes of laparoscopic versus open appendectomy in elderly using ACS/NSQIP database. Surg Endosc 27(4):1061–1071CrossRef
20.
Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT et al (2012) Does laparoscopic appendectomy impart an advantage over open appendectomy in elderly patients? World J Surg 36(7):1534–1539CrossRef
21.
Cohen-Arazi O, Dabour K, Bala M, Haran A, Almogy G (2017) Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience. Eur J Trauma Emerg Surg 43(5):723–727CrossRef
22.
Yang J, Yu K, Li W, Si X, Zhang J, Wu W et al (2017) Laparoscopic appendectomy for complicated acute appendicitis in the elderly: a single-center experience. Surg Laparosc Endosc Percutaneous Tech 27(5):366–368CrossRef
23.
Pooler BD, Lawrence EM, Pickhardt PJ (2012) MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radiol 19(1):27–33CrossRef
24.
Segev L, Keidar A, Schrier I, Rayman S, Wasserberg N (2015) Sadot E: acute appendicitis in the elderly in the twenty-first century. J gastrointest surg 19(4):730–735CrossRef
25.
Zbierska K, Kenig J, Lasek A, Rubinkiewicz M, Wałęga P (2016) Differences in the clinical course of acute appendicitis in the elderly in comparison to younger population. Pol Przegl Chir 88(3):142–146CrossRef
26.
Deiters A, Drozd A, Parikh P, Markert R, Shim JK (2019) Use of the alvarado score in elderly patients with complicated and uncomplicated appendicitis. Am Surg 85(4):397–402CrossRef
27.
Wu T-C, Lu Q, Huang Z-Y, Liang X-H (2017) Efficacy of emergency laparoscopic appendectomy in treating complicated appendicitis for elderly patients. Saudi Med J 38(11):1108–1112CrossRef
28.
Lasek A, Pędziwiatr M, Kenig J, Walędziak M, Wysocki M, Mavrikis J et al (2018) The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the polish laparoscopic appendectomy multicenter large cohort study. Medicine 97(50):e13621CrossRef
29.
Wu S-C, Wang Y-C, Fu C-Y, Chen R-J, Huang H-C, Huang J-C et al (2011) Laparoscopic appendectomy provides better outcomes than open appendectomy in elderly patients. Am Surg 77(4):466–470CrossRef
30.
Poillucci G, Podda M, Pisanu A, Mortola L, Dalla Caneva P, Massa G, Costa G, Savastano R, Cillara N, ERASO (Elderly Risk Assessment And Surgical Outcome) Collaborative Study Group (2019) Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study. Eur J Trauma Emerg Surg. https://​doi.​org/​10.​1007/​s00068-019-01186-2 (Epub ahead of print)CrossRefPubMed
31.
Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C et al (2018) Emergency general surgery in geriatric patients: a statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg 84(6):864–875CrossRef
32.
Angeramo CA, Dreifuss NH, Giacone J, Schlottmann F (2020) Outcomes of acute appendicitis in elderly patients: a single center Analysis of 2000 laparoscopic appendectomies. J gastrointest surg 24(12):2859–2861CrossRef
33.
Mentula P, Sammalkorpi H, Leppäniemi A (2015) Laparoscopic surgery or conservative treatment for appendiceal abscess in adults? A randomized controlled trial. Ann Surg 262(2):237–242CrossRef
34.
Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B et al (2011) Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet 377(9777):1573–1579CrossRef
35.
Talan DA, Saltzman DJ, Mower WR, Krishnadasan A, Jude CM, Amii R et al (2017) Antibiotics-first versus surgery for appendicitis: a US pilot randomized controlled trial allowing outpatient antibiotic management. Ann Emerg Med 70(1):1-11.e9CrossRef
36.
Ceresoli M, Pisano M, Allievi N, Poiasina E, Coccolini F, Montori G et al (2019) Never put equipoise in appendix! Final results of ASAA (antibiotics vs. surgery for uncomplicated acute appendicitis in adults) randomized controlled trial. Updates surg 71(2):381–387CrossRef
37.
Flum DR, Davidson GH, Monsell SE, Shapiro NI, Odom SR, Sanchez SE et al (2020) A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med 383(20):1907–1919CrossRef
38.
Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T et al (2015) Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA 313(23):2340–2348CrossRef
39.
Sippola S, Haijanen J, Viinikainen L, Grönroos J, Paajanen H, Rautio T et al (2020) Quality of life and patient satisfaction at 7-year follow-up of antibiotic therapy vs appendectomy for uncomplicated acute appendicitis: a secondary analysis of a randomized clinical trial. JAMA Surg 155(4):283–289CrossRef
40.
Haijanen J, Sippola S, Tuominen R, Grönroos J, Paajanen H, Rautio T et al (2019) Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial. PLoS ONE 14(7):e0220202CrossRef
41.
Duan Y, Yang H, Yang Y, Wang G, Wang T, Chen Z et al (2018) Application of laparoscopy in acute appendicitis for the elderly: a single center experience. Biomed Res 8(29):1681–1684
42.
Ferrarese AG, Martino V, Enrico S, Falcone A, Catalano S, Pozzi G et al (2013) Laparoscopic appendectomy in the elderly: our experience. BMC Surg 13(Suppl 2):S22CrossRef
43.
Chong VE, Lee WS, Victorino GP, Liu TH (2014) Antibiotics vs appendectomy as initial treatment for uncomplicated acute appendicitis: a cost-effectiveness analysis. J Am Coll Surg 219(3):S95–S96CrossRef
44.
Hanson AL, Crosby RD, Basson MD (2018) Patient preferences for surgery or antibiotics for the treatment of acute appendicitis. JAMA Surg 153(5):471–478CrossRef
45.
Rockwood K, Theou O (2020) Using the clinical frailty scale in allocating scarce health care resources. Can Geriatr J 23(3):210–215CrossRef
46.
Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536CrossRef
Metadata
Title
EAES rapid guideline: appendicitis in the elderly
Authors
Stavros A. Antoniou
Dimitris Mavridis
Katerina Maria Kontouli
Vasileios Drakopoulos
Marguerite Gorter-Stam
Sture Eriksson
Marc Leone
Maria Carmen Pérez-Bocanegra
Neil J. Smart
Marco Milone
Francesco Maria Carrano
George A. Antoniou
Per Olav Vandvik
Publication date
01-07-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-021-08524-9

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