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Appendicitis as a Critical Illness in the Elderly: Who is at Risk?
*Courtney Collins, *Julie M Flahive, *Fred A Anderson, Jr, *Heena P Santry
University of Massachusetts, Worcester, MA
Objective:
To identify the impact of sociodemographic and clinical risk factors on the need for ICU care in elderly patients with acute appendicitis.Design:
Retrospective review of a 5% random sample national Medicare claims data (2009-2011).Setting:
All US acute care hospitals accepting Medicare patients during the study period.Patients:
Medicare beneficiaries age ≥65yrs admitted urgently or emergently with a primary ICD-9 diagnosis code of acute appendicitis (540.x). Interventions:
Main Outcome Measures:
Differences in sociodemographic characteristics (age, race, gender) and key comorbidities between patients who did and did not require intensive care during their admission for acute appendicitis were determined using bivariate analyses and a multivariable logistic regression model. Results:
1085 elderly patients were admitted with acute appendicitis. The majority were female (58%), white (84%), and in the 7th decade of life (mean age 75yrs SD7.3). Despite relatively few comorbidities (mean Elixhauser 0.8,SD 1.8) and low mortality (1%) nearly 1 in 5 patients (19%) required an ICU stay. Patients requiring ICU care were more likely to be male, older, and had more comorbidities than patients who did not(Table 1). In multivariable analyses, independent predictors of ICU care were male gender (OR 1.7(95% CI 1.2-2.3)), 5 year increase in age (1.4(1.3-1.5)) and congestive heart failure (2.5(1.4-4.4))Conclusions:
Nearly 1 in 5 elderly Americans admitted with appendicitis will require ICU care. This diagnosis, though common and typically straightforward in younger patients, should not be considered low risk among elder patients, in particular for older men with a history of heart failure.
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