Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;35(7):3233-3243.
doi: 10.1007/s00464-021-08524-9. Epub 2021 May 17.

EAES rapid guideline: appendicitis in the elderly

Stavros A Antoniou  1   2 , Dimitris Mavridis  3   4 , Katerina Maria Kontouli  3 , Vasileios Drakopoulos  5 , Marguerite Gorter-Stam  6 , Sture Eriksson  7 , Marc Leone  8 , Maria Carmen Pérez-Bocanegra  9 , Neil J Smart  10 , Marco Milone  11 , Francesco Maria Carrano  12   13 , George A Antoniou  14   15 , Per Olav Vandvik  16
Affiliations

EAES rapid guideline: appendicitis in the elderly

Stavros A Antoniou et al. Surg Endosc. 2021 Jul.

Abstract

Background: There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients.

Methods: We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

Results: This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 .

Conclusions: This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.

Keywords: AGREE II; Acute appendicitis; Clinical practice guideline; EAES; Elderly; GRADE; Rapid guideline.

PubMed Disclaimer

References

    1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925 - DOI
    1. Naar L, Kim P, Byerly S, Vasileiou G, Zhang H, Yeh DD et al (2020) Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: a post hoc analysis of an EAST multicenter study. Surgery 168(4):701–706 - DOI
    1. Mohamed I, Chan S, Bhangu A, Karandikar S (2019) Appendicitis as a manifestation of colon cancer: should we image the colon after appendicectomy in patients over the age of 40 years? Int J Colorectal Dis 34(3):527–531 - DOI
    1. Etkind SN, Bone AE, Lovell N, Higginson IJ, Murtagh FEM (2018) Influences on care preferences of older people with advanced Illness: a systematic review and thematic synthesis. J Am Geriatr Soc 66(5):1031–1039 - DOI
    1. TNS Qual+ 2014 Eurobarometer qualitative study. Patient involvement. Available in: https://ec.europa.eu/health//sites/health/files/systems_performance_asse... . Accessed 1Apr 2021

Publication types

LinkOut - more resources