Utility of fever and leukocytosis in acute surgical abdomens in octogenarians and beyond

Abstract

Background: The study determined the incidence of specific surgical diagnoses in patients age 80 years or older who presented to an emergency department (ED) with acute abdomens and required emergency surgical intervention within 72 hours. The usefulness of an increase in temperature and leukocytosis in the evaluation of each surgical diagnostic group is discussed.

Methods: The study was a retrospective review of ED records and operative reports of patients 80 years or older who were seen from November 1992 to September 1995 at a large midwestern tertiary-care ED with 65,000 annual patient visits.

Results: Among the 117 patients who met the inclusion criteria, the most common diagnoses were acute cholecystitis (29 patients), hernia (24), and bowel obstruction (19). The least common diagnoses were Meckel's diverticulum (1 patient), diverticulitis (1), and a carcinoid tumor (1). Temperature increase to more than 37.5 degrees C was statistically more common in patients with acute cholecystitis (13 of 29) and viscus perforation (4 of 11) than in all other patient groups (4 of 77). A leukocyte count of more than 15,500/mm3 was most statistically suggestive of acute cholecystitis (10 of 29 patients), intestinal ischemia (5 of 11), viscus perforation (5 of 11), acute appendicitis (2 of 3), and abscess (1 of 2). Of 115 patients with a recorded temperature and leukocyte count, 35 had a temperature of less than 37.5 degrees C and a leukocyte count of less than 10,500/mm3.

Conclusion: Acute surgical abdomen in patients 80 years or older has a unique distribution of diagnoses. Although an increase in temperature and marked leukocytosis are not diagnostic of any particular illness, their presence should suggest certain specific surgical illnesses to the practicing clinician. Frequently, elderly patients with acute surgical abdomens present with a normal temperature and leukocyte count.