Abstract
Background
Acute appendicitis in elderly patients is associated with atypical clinical presentation, delayed diagnosis, and increased morbidity and mortality. While non-operative management (NOM) has gained acceptance in selected patients, its safety and effectiveness in very elderly and frail populations remain controversial.
Methods
This retrospective cohort study included 300 patients aged ≥ 65 years diagnosed with acute appendicitis between 2014 and 2025. Patients were classified according to World Health Organization age groups (65–74, 75–84, and ≥ 85 years). Clinical features, laboratory findings, imaging results, treatment modality (non-operative vs. surgical), treatment failure, complications, intensive care unit (ICU) requirement, length of hospital stay, and mortality were analyzed. Factors associated with non-operative management failure and postoperative outcomes were evaluated.
Results
Eighty-three patients (27.7%) were initially managed non-operatively, and 217 patients (72.3%) underwent surgical treatment. In the non-operative group, early treatment failure requiring surgery within 30 days occurred in 24.1%, and recurrence requiring surgery within one year occurred in 25.3%. Failure rates increased significantly with age, reaching 54.5% in patients aged ≥ 85 years (P < 0.001). High frailty index, severe comorbidities, prolonged symptom duration, and extensive inflammatory findings on computed tomography were significantly associated with non-operative management failure.
In the surgical group, increasing age was significantly associated with higher rates of open surgery, intraoperative conversion, postoperative complications, perforated appendicitis, ICU admission, prolonged hospital stay, and early postoperative mortality (all P < 0.001).
Conclusion
Age and frailty strongly influence outcomes in elderly patients with acute appendicitis. Patients aged ≥85 years have markedly higher risks of non-operative treatment failure, postoperative complications, and mortality. Non-operative management should be reserved for carefully selected elderly patients and requires close monitoring. Early diagnosis and individualized, frailty-based treatment strategies are essential to improve clinical outcomes in this population.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12877-026-07499-3.
Keywords: Appendicitis, Geriatric, Aged 65 and over, Frailty, Appendectomy
Introduction
Acute appendicitis can occur at any age but poses substantial diagnostic and therapeutic challenges in elderly patients. According to the World Health Organization (WHO), older adults are classified as young-old (65–74 years), middle-old (75–84 years), and old-old (≥ 85 years) [1, 2]. Advancing age is associated with decreased physiological reserve, increased comorbidities, cognitive impairment, weakened immune responses, and altered pain perception, all of which may obscure the clinical presentation of acute abdominal conditions [3]. In patients aged ≥ 85 years, communication difficulties and functional dependence frequently delay emergency department presentation and increase the risk of perforation [4, 5].
Classic signs of appendicitis are often absent in elderly individuals. Atypical presentations occur in 30–60% of cases, leading to diagnostic delays and perforation rates that are 2–4 times higher than those observed in younger populations [6–9]. While appendicitis in younger patients is commonly related to anatomical factors and active lymphoid tissue, its occurrence in elderly individuals may be linked to age-related regression of lymphoid tissue and delayed inflammatory responses [10].
The diagnostic value of laboratory markers such as leukocytosis, C-reactive protein (CRP), and neutrophil percentage decreases with advancing age, particularly in patients aged ≥ 85 years [11]. Similarly, the performance of the Alvarado Score is significantly reduced in elderly patients [3, 12, 13]. Systematic reviews have reported increased false-negative rates in individuals aged ≥ 65 years, indicating that even high scores may fail to reliably exclude perforation [14]. Cognitive impairment and a blunted inflammatory response further limit the usefulness of clinical scoring systems in very elderly patients [15].
Frailty has recently gained attention as an important prognostic factor in geriatric appendicitis. The frailty index, which incorporates variables such as comorbidities, functional status, and nutritional condition, has been associated with increased risks of perforation and failure of conservative treatment [2].
Management outcomes of acute appendicitis vary considerably across geriatric age groups. Although a medical treatment failure rate of approximately 20% may be acceptable in younger populations, similar rates in elderly patients may result in increased morbidity and mortality due to delayed surgical intervention. Mortality following appendectomy is rare in younger individuals but occurs predominantly in older adults, often in association with cardiovascular comorbidities [10].
This study aims to compare clinical characteristics, diagnostic parameters, risk factors for perforation, and outcomes of surgical versus medical management of acute appendicitis across geriatric subgroups defined by the WHO age classification, with the goal of supporting optimized and age-appropriate treatment strategies.
Methods
This retrospective observational cohort study was conducted at a tertiary university hospital in accordance with the Declaration of Helsinki and was approved by the local ethics committee on 17/10/2025 (Decision No: 2025/10–45).
Medical records of patients aged ≥ 65 years diagnosed with acute appendicitis between January 2014 and December 2025 were reviewed retrospectively. Patients with prior appendectomy, alternative acute abdominal diagnoses, or incomplete data were excluded. A total of 300 patients were included: 217 underwent surgical treatment, and 83 received initial conservative management. Analyses were performed separately for the surgical and conservative groups.
Patients were categorized according to World Health Organization age groups as young-old (65–74 years), middle-old (75–84 years), and old-old (≥ 85 years). Data extracted from emergency department records included presenting symptoms, physical examination findings, Alvarado scores, laboratory parameters (white blood cell count, neutrophil percentage, and C-reactive protein), and imaging results. Ultrasonography was used as the initial imaging modality, followed by computed tomography when findings were inconclusive. Radiological diagnosis was based on standard ultrasonography and CT criteria for appendicitis.
Conservative management (antibiotic therapy) was administered to hemodynamically stable patients without generalized peritonitis or sepsis and with radiological findings consistent with uncomplicated appendicitis. In patients with localized abscess formation, percutaneous drainage was performed in addition to antibiotic therapy. Conservative treatment was also preferred in patients with high operative risk. Antibiotic regimens were individualized following infectious disease consultation. Conservative management included intravenous antibiotics, fluid therapy, close clinical monitoring, and repeat laboratory and ultrasonographic evaluations at 24 and 48 h. Conversion to surgery was undertaken in cases of clinical or radiological deterioration.
Early treatment failure was defined as conversion to surgery within 30 days, and late failure as recurrence requiring surgery within one year. For surgically treated patients, operative reports were reviewed to determine surgical approach, intraoperative findings, and conversions from laparoscopic to open surgery. Surgical technique was selected based on patient’s condition and clinical judgment.
Patient interval (symptom onset to hospital presentation), hospital interval (emergency admission to surgery), postoperative outcomes, length of hospital and intensive care stay, pathology results, and comorbidities were recorded. Postoperative mortality was defined as Clavien–Dindo Grade V complications. Frailty index scores were calculated retrospectively using a deficit accumulation model based on available clinical data and analyzed as associative variables.
Statistical analysis
Statistical analyses were performed using SPSS software (IBM, Armonk, NY). Normality of distributions was assessed using the Shapiro–Wilk test. Patients were divided into three groups according to age: Group 1 (65–74 years), Group 2 (75–84 years), and Group 3 (≥ 85 years). Because the data did not show normal distribution, nonparametric tests were used (Mann–Whitney U test, Wilcoxon test, or Kruskal–Wallis H test). The chi-square test was used to compare categorical variables. A p-value < 0.05 was considered statistically significant.
Results
A total of 300 elderly patients with acute appendicitis were included in the study, of whom 83 were managed conservatively, and 217 underwent surgical treatment. Analyses were first performed according to treatment modality and subsequently according to World Health Organization age groups (Table 1).
Table 1.
Comparison of clinical outcomes between medically and surgically treated elderly patients with acute appendicitis
| Parameters | Medical Treatment (n = 83) | Surgical Treatment (n = 217) | p |
|---|---|---|---|
| Median age (years) | 74 (65–96) | 71 (65–98) | NS |
| Length of hospital stay (days) | 5 (4–8) | 9 (6–14) | 0.003 |
| ICU requirement, n (%) | 8 (9.6%) | 61 (28.1%) | < 0.001 |
| ICU length of stay (days) | 2 (1–4) | 3 (2–6) | 0.018 |
| 30-day treatment failure / conversion to surgery, n (%) | 20 (24.1%) | Not applicable | – |
| One-year recurrence or need for surgery, n (%) | 21 (25.3%) | Not applicable | – |
| Mortality, n (%) | 1 (1.2%) | 6 (2.8%) | NS |
Mortality refers to Clavien–Dindo Grade V complications. Data are presented according to WHO age classification (65–74, 75–84, ≥ 85 years) and are consistent with outcome definitions used in Table 1. ICU, intensive care unit; IQR, interquartile range; NS, not significant; values are presented as median (IQR) or number (percentage), as appropriate, and “Not applicable” indicates outcomes specific to conservative (medical) management for which comparison with the surgical group is not defined
Medically treated patients had a significantly shorter median length of hospital stay compared with surgically treated patients (5 vs. 9 days, p = 0.003). However, patients who failed conservative treatment and required surgery within 30 days experienced longer hospitalization (median 12 days, IQR 9–18) and a higher rate of intensive care unit (ICU) admission (40%, p < 0.01). Overall ICU requirement was higher in the surgical group (28.1%), whereas ICU admission in the medical group occurred almost exclusively in patients with treatment failure. Mortality was observed predominantly in surgically treated patients aged ≥ 85 years (Table 1). Postoperative mortality, defined as Clavien–Dindo Grade V complications, occurred in 7 patients, of whom 2 were aged ≥ 85 years.
Among the 83 patients initially treated conservatively, 48 were aged 65–74 years, 24 were aged 75–84 years, and 11 were aged ≥ 85 years. Early treatment failure requiring surgery within 30 days occurred in 20 patients (24.1%, 95% CI: 0.16–0.34). Failure rates increased significantly with age, from 14.6% in patients aged 65–74 years to 29.2% in those aged 75–84 years and 54.5% in those aged ≥ 85 years (p < 0.001). Within one year, 21 patients (25.3%, 95% CI: 0.17–0.36) required surgery due to recurrence following initial medical treatment, with recurrence rates again increasing with age (p < 0.01). Higher frailty index values, severe comorbidities, prolonged patient interval, and extensive inflammatory findings on computed tomography were significantly associated with failure of conservative management (Table 1).
All surgically treated patients underwent operative intervention, with most procedures performed on the day of admission (median hospital interval: 0 days, range 0–3). Laparoscopic appendectomy was performed in 111 patients (51.2%), open appendectomy in 106 patients (48.8%), and conversion from laparoscopy to open surgery occurred in 29 cases (26.1%) (Table 2). The median age of operated patients was 71 years (range 65–98 years), and 65% were female (p < 0.001). The median patient interval was 2 days (range 1–21 days) and increased significantly with advancing age (Fig. 1).
Table 2.
Evaluations of the parameters according to age groups (Chi-square test)
| Parameters | Analysis | Group 1 | Group 2 | Group 3 | p value | Female | Male | p value |
|---|---|---|---|---|---|---|---|---|
| Sex | Female | 91 (64.5%) | 39 (27.7%) | 11 (7.8%) | 0.775 | - | - | - |
| Male | 51 (67.1%) | 27 (27.6%) | 4 (5.3%) | - | - | - | ||
| Surgical technique | Laparoscopic | 82 (73.9%) | 23 (20.7%) | 6 (5.4%) | 0.028 | 65 (58.6%) | 46 (41.4%) | 0.043 |
| Open | 60 (56.6%) | 37 (34.9%) | 9 (8.5%) | 76 (71.7%) | 30 (28.3%) | |||
| Diagnostic method | USG | 95 (82.6%) | 19 (16.5%) | 1 (0.9%) | < 0.001 | 67 (58.3%) | 48 (41.7%) | 0.028 |
| CT | 47 (46.1%) | 41 (40.2%) | 14 (13.7%) | 74 (72.5%) | 28 (27.5%) | |||
| Pre-op fever | No | 30 (48.4%) | 22 (35.5%) | 10 (16.1%) | < 0.001 | 41 (66.1%) | 21 (33.9%) | 0.822 |
| Yes | 112 (72.3%) | 38 (24.5%) | 5 (3.2%) | 100 (64.5%) | 55 (35.5%) | |||
| Defense | No | 9 (23.7%) | 17 (44.7%) | 12 (31.6%) | < 0.001 | 26 (68.4%) | 12 (31.6%) | 0.624 |
| Yes | 133 (74.3%) | 43 (24%) | 3 (1.7%) | 115 (64.2%) | 64 (35.8%) | |||
| Rebound | No | 9 (22.5%) | 19 (47.5%) | 12 (30%) | < 0.001 | 27 (67.5%) | 13 (32.5%) | 0.711 |
| Yes | 133 (75.1%) | 41 (23.2%) | 3 (1.7%) | 114 (64.4%) | 63 (35.6%) | |||
| Pain migration | No | 11 (26.8%) | 18 (43.9%) | 12 (29.3%) | < 0.001 | 28 (68.3%) | 13 (31.7%) | 0.621 |
| Yes | 131 (74.4%) | 42 (23.9%) | 3 (1.7%) | 113 (64.2%) | 63 (35.8%) | |||
| Appetite | No | 138 (66%) | 56 (26.8%) | 15 (7.2%) | 0.309 | 136 (65.1%) | 73 (34.9%) | 0.881 |
| Yes | 4 (50%) | 4 (50%) | 0 (0%) | 5 (62.5%) | 3 (37.5%) | |||
| Vomit | No | 5 (55.6%) | 4 (44.4%) | 0 (0%) | 0.417 | 6 (66.7%) | 3 (33.3%) | 0.914 |
| Yes | 137 (65.9%) | 56 (26.9%) | 15 (7.2%) | 135 (64.9%) | 73 (35.1%) | |||
| Response to painkillers | No | 135 (65.2%) | 57 (27.5%) | 15 (7.2%) | 0.677 | 135 (65.2%) | 72 (34.8%) | 0.736 |
| Yes | 7 (70%) | 3 (30%) | 0 (0%) | 6 (60%) | 4 (40%) | |||
| Comorbid disease | No | 129 (75%) | 41 (23.8%) | 2 (1.2%) | < 0.001 | 112 (65.1%) | 60 (34.9%) | 0.933 |
| Yes | 13 (28.9%) | 19 (42.2%) | 13 (28.9%) | 29 (64.4%) | 16 (35.6%) | |||
| Conversion (laparoscopic to open) | No | 135 (71.8%) | 46 (24.5%) | 7 (3.7%) | < 0.001 | 123 (65.4%) | 65 (34.6%) | 0.724 |
| Yes | 7 (24.1%) | 14 (48.3%) | 8 (27.6%) | 18 (62.1%) | 11 (37.9%) | |||
| Wound infection | No | 137 (71.7%) | 44 (23%) | 10 (5.2%) | < 0.001 | 124 (64.9%) | 67 (35.1%) | 0.963 |
| Yes | 5 (19.2%) | 16 (61.5%) | 5 (19.2%) | 17 (65.4%) | 9 (34.6%) | |||
| Intra-abdominal abscess | No | 139 (73.2%) | 47 (24.7%) | 4 (2.1%) | < 0.001 | 122 (64.2%) | 68 (35.8%) | 0.530 |
| Yes | 3 (11.1%) | 13 (48.1%) | 11 (40.7%) | 19 (70.4%) | 8 (29.6%) | |||
| Pathology findings | Negative appendectomy | 10 (90.9%) | 1 (9.1%) | 0 (0%) | < 0.001 | 7 (63.6%) | 4 (36.4%) | 0.815 |
| Acute appendicitis | 128 (70.2%) | 47 (25.8%) | 7 (3.8%) | 117 (64.3%) | 65 (35.7%) | |||
| Perforated appendicitis | 4 (16.7%) | 12 (50%) | 8 (33.3%) | 17 (70.8%) | 7 (29.2%) |
Group 1: Young-old; Group 2: Mid-old; Group 3: Old-old
Fig. 1.
Patient interval with age
Abdominal pain was present in all patients, whereas other clinical findings varied significantly according to age group (Table 3). Comorbid diseases were present in 20.7% of patients, most commonly chronic kidney disease and hypertension. Median laboratory values were 11.8 × 10³/µL for white blood cell count, 9.4 × 10³/µL for neutrophils, and 61.3 mg/L for C-reactive protein (Table 3).
Table 3.
Demographics, symptoms, and laboratory findings
| Evaluated parameters | Analysis | Number | p value |
|---|---|---|---|
| Sex | Total | n = 217 | < 0.001 |
| Female | n = 141 | ||
| Male | n = 76 | ||
| Age | Total | 71 years (65–98 years) | 0.601 |
| Female | 70 years (65–98 years) | ||
| Male | 72 years (65–92 years) | ||
| Symptoms* | Pain | 217 (100%) | |
| Fever | 155 (71.4%) | ||
| Defense | 179 (82.5%) | ||
| Rebound | 177 (81.6%) | ||
| Pain migration | 176 (81.1%) | ||
| Loss of appetite | 209 (96.3%) | ||
| Vomit | 208 (95.9%) | ||
| Negative response to painkillers | 207 (95.4%) | ||
| Comorbid disease | 45 (20.7%) | ||
| Intra-abdominal abscess | 27 (12.4%) | ||
| Wound infection | 26 (12%) | ||
| Laboratory findings | WBC (10^3/uL) | 11.80 (1.60–30.30) | |
| Neutrophils (10³/uL) | 9.40 (0.60–27.80) | ||
| CRP (mg/dL) | 61.30 (2-530.80) |
Values indicate the presence of the corresponding clinical symptom unless otherwise specified
Postoperative wound infection occurred in 12% of patients. According to the Clavien–Dindo classification, Grade I–II complications were observed in 9.2% of cases and Grade III complications in 2.8%. Two early postoperative deaths occurred in patients aged ≥ 85 years and were classified as Grade V. Pathological examination revealed negative appendectomy in 5.1% of cases, acute appendicitis in 83.9%, and perforated appendicitis in 11% (Table 2).
Age-group analysis showed that 65.4% of surgically treated patients were aged 65–74 years, 27.7% were aged 75–84 years, and 6.9% were aged ≥ 85 years (p < 0.001). Patient interval, complication rates, perforation rates, ICU requirement, and length of hospital stay increased significantly with age (all p < 0.001) (Table 2, Figs. 1 and 2). Open surgery and conversion rates were also higher in older age groups (Table 2). Sex was not associated with patient or hospital interval; however, computed tomography use and open surgery were more frequent in female patients (p < 0.05). ICU admission occurred in 28.1% of operated patients overall and increased from 18% in patients aged 65–74 years to 46% in those aged ≥ 85 years (p < 0.001) (Fig. 2). The relative risk of ICU admission in patients aged ≥ 85 years was approximately 2.6.
Fig. 2.
Hospital interval with age
Overall, increasing age and frailty were strongly associated with higher rates of medical treatment failure, postoperative complications, ICU requirement, and prolonged hospitalization, with the most unfavorable outcomes observed in patients aged ≥ 85 years.
Discussion
In recent years, the effectiveness of medical management for uncomplicated appendicitis—particularly when considered in the context of comorbidities in older adults—has led to ongoing debate regarding the optimal balance between operative and non-operative approaches in geriatric patients. The findings of this study demonstrate that acute appendicitis in the geriatric population presents with more subtle and atypical clinical findings compared with younger adults, leading to diagnostic delays and higher complication rates. This pattern is consistent with the WHO classification of aging and the suppressive effects of physiological aging on immune response [1, 2].
In our cohort, typical clinical signs such as fever, guarding, rebound tenderness, and pain migration decreased significantly with advancing age, a trend that is well documented in the literature [6, 12, 16, 17]. The attenuation of clinical presentation prolongs both patient-related and hospital-related delays, particularly in individuals ≥ 85 years, and results in higher rates of perforation. Similar observations have been reported in large population-based studies [5, 15, 18].
The limited diagnostic value of laboratory markers in older adults aligns with the known reduction in immune reactivity with age; prior studies show decreased sensitivity of WBC, neutrophil count, and CRP in patients ≥ 80 years [11, 13, 19]. Thus, laboratory-based decision-making algorithms may be insufficient in this population, emphasizing the critical role of radiological confirmation. Likewise, we observed a decline in the diagnostic reliability of the Alvarado score with increasing age, consistent with studies reporting high false-negative rates and limited ability to predict perforation in elderly patients [9, 15]. While the Alvarado score is already known to be unreliable in children and pregnant patients, our findings reinforce that it is also inadequate as a stand-alone diagnostic tool in the geriatric population.
The increased use of CT imaging with advancing age in our study parallels previous literature. Ultrasonography has been shown to have reduced sensitivity in older patients, while CT provides high diagnostic accuracy and reduces delayed diagnosis [4, 20, 21]. Thus, CT imaging—as long as contrast-related risks are cautiously assessed—should be strongly considered as the first-line modality when appendicitis is suspected in elderly individuals.
While 1-year failure or recurrence rates for non-operative management (NOM) in the general population typically range from 20 to 30%, numerous studies report substantially higher rates in older or frail patients. Systematic reviews emphasize that diagnostic delays, increased perforation rates, and the importance of frailty-based rather than age-based decision-making are central considerations in managing geriatric appendicitis. Therefore, higher NOM failure rates observed in the ≥ 85-year group in our study are both physiologically and epidemiologically expected. Recent geriatric-focused investigations also indicate that conservative treatment is safe only in selected and carefully evaluated cases; in contrast, frailty, multimorbidity, and advanced age significantly increase the risks of NOM failure and mortality [8, 17, 22].
In our study, NOM was preferred for hemodynamically stable patients without signs of abscess or generalized peritonitis, without sepsis criteria, and with comorbidities that would pose elevated surgical risk—a selection strategy consistent with the recommended indications for non-operative management. This reflects contemporary evidence showing that conservative treatment is safe only in selected, uncomplicated cases [23].
From a surgical perspective, the observed increase in open surgery and intraoperative conversion rates with advancing age is likely related to the higher prevalence of complicated appendicitis and anatomical difficulties encountered in older adults. However, current meta-analyses show that laparoscopy offers advantages over open surgery in the elderly, including lower mortality, reduced wound infection rates, and shorter hospital stays [7, 24, 25]. Therefore, laparoscopy should remain the preferred approach in geriatric patients whenever feasible, while maintaining an awareness of the higher likelihood of conversion in complicated presentations.
The rising incidence of complicated and perforated appendicitis with age in our study is consistent with delayed diagnosis, attenuated immune responses, and the higher overall burden of comorbidities in geriatric patients. This pattern has been confirmed in numerous large-scale studies [5, 18, 26–28]. Although interest in conservative management has grown in recent years, evidence indicates that NOM significantly increases mortality in frail older adults [27]. Thus, conservative treatment should be offered only in carefully selected geriatric cases in which frailty has been formally evaluated [2, 29].
Our findings further highlight that frailty-based decision-making is not merely a recommended concept but should be an integral component of clinical management. The markedly higher failure rates of medical management in the ≥ 85-year group can be explained by physiological factors characteristic of advanced age, including significantly suppressed immune function, elevated baseline inflammatory tone, impaired tissue perfusion, microvascular dysfunction, and sarcopenia-related delays in inflammatory response—all of which predispose to perforation. These biological features limit the effectiveness of antibiotic therapy and increase the likelihood of NOM failure. Multimorbidity and polypharmacy, both common in this age group, further impair infection control [1, 2, 6, 14, 29].
The strong association between NOM failure and frailty, comorbidity burden, and immunological insufficiency in our study suggests that treatment strategies for geriatric acute appendicitis require re-evaluation. This is consistent with broad evidence indicating that appendicitis in elderly patients follows a more complicated course and that non-operative approaches carry higher risks of failure and mortality [6, 17, 27].
Recent technological advances, such as the Internet of Things (IoT) may support early diagnosis and monitoring in acute appendicitis, especially in elderly patients with atypical presentation [30].
The diagnosis of acute appendicitis relies on a combination of clinical findings, laboratory markers, and imaging modalities such as ultrasound and CT [31].
Three-dimensional printing may assist in anatomical visualization and surgical planning in selected appendicitis cases [32].
Intra-abdominal abscess formation remains a debated complication between laparoscopic and open appendectomy, particularly in complicated cases [24]. Appendiceal tumors may be incidentally detected in appendectomy specimens and are clinically important, especially in elderly patients [26].
We also believe that, in geriatric patients, hesitancy in surgical decision-making or delays attributable to surgical judgment contributed to prolonged hospital intervals in our cohort. Furthermore, although not statistically significant, our findings show that patient interval was notably longer during the winter season and increased with age, suggesting that seasonal factors may influence healthcare-seeking behavior.
Limitations of the study
This study is limited by its retrospective design and reliance on medical records, which led to the exclusion of cases with incomplete data and may have reduced generalizability. Several factors potentially affecting disease severity and outcomes—such as detailed comorbidity profiles, immune status, chronic medication use, lifestyle factors, and nutritional status—could not be analyzed due to inconsistent documentation.
Causal relationships cannot be established, and findings should therefore be interpreted as associative. In addition, frailty could not be comprehensively assessed retrospectively, which may have introduced bias in risk stratification among elderly patients. Despite these limitations, the study reflects real-world clinical practice and provides clinically relevant data on appendicitis management in older adults.
Conclusion
This study demonstrates that advancing age is associated with atypical clinical presentation, reduced diagnostic reliability of laboratory parameters and the Alvarado score, increased reliance on computed tomography, and higher rates of complications and mortality. A frailty-centered approach and timely surgical decision-making are essential, particularly in patients aged ≥ 85 years. By identifying age-dependent differences in presentation, management, and outcomes, these findings support more individualized and evidence-based strategies for the management of acute appendicitis in geriatric patients.
Supplementary Information
Acknowledgements
I would like to express my sincere gratitude to my esteemed mentor Mehmet Çetin Kotan, who guided me throughout my surgical journey, broadened my professional perspective with his knowledge and experience, and honored me by contributing significantly to this article as a co-author.
Authors’ contributions
F.A. contributed to study conception, design, obtaining ethical approval, data collection and analysis, drafting the manuscript, and providing final approval. S.B., MOO contributed to data collection, clinical evaluations, support in statistical analysis, and drafting and revising the manuscript. İE, HAB, and B.B. participated in the evaluation of pediatric surgery cases, contributed to data analysis, and assisted with the literature review. O.B. contributed to anatomical evaluations, literature support, and methodology development. ME, M.C.K., contributed to study design, verification of clinical data, interpretation of results, and critical revision of the manuscript. All authors have read and approved the final version of the manuscript.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Non-Interventional Clinical Research Ethics Committee of Van Yüzüncü Yıl University (Approval No: 2025/10–45; Date: 17/10/2025). Due to the retrospective nature of the study, informed consent was waived by the committee.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.