ABSTRACT
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 â% [95 â% CI 6.9 â%-8.1 â%]), LOS (3 day [95 â% CI 3-4]), costs ($9015 [95 â% CI $8216- $9446]), and discharges to skilled facilities (1 â% [95 â% CI 0.9 â%-1.6 â%]) compared to successful nonoperative treatment. Patients ≥65 had differences in morbidity (14 â% [95 â% CI 13.6 â%-16.2 â%]), LOS (6 days [95 â% CI 5-6]), costs ($15,964 [95 â% CI $15,181- $17,708]), and discharges to skilled facilities (12 â% [95 â% CI: 10.0 â%-13.3]) compared to nonoperative success. CONCLUSIONS: Nonoperative management of appendicitis should be approached cautiously for older adults.