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.