Acute Appendicitis in the Elderly: Evaluating Value Across the Appendicitis Care Episode and Risk of Malignancy

Introduction More than 250,000 appendectomies are performed annually in the US, with perforated appendicitis associated with increased morbidity and resource utilization. This study evaluates value across the appendicitis care episode within a health network, focusing on the impact of patient factors and disease severity on treatment strategies, outcomes, and cost. Methods Adult patients were identified from the Health Network System data warehouse, with pathology reports reviewed for confirmation. Quality metrics included postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), and textbook outcome (TB). Cost was assessed using total charges (TCs) for the index admission. Perforated appendicitis was managed with percutaneous drainage and intravenous antibiotics, followed by interval appendectomy when appropriate. Uni- and multivariable analyses were performed. Results Among 1637 appendectomies, 95% were performed using minimally invasive techniques (3% conversion, 2% open). Most patients were <50 years (75%; mean age 30.5 ± 9.1), while 25% were ≥50 years (mean age 61.0 ± 8.7), with higher comorbidity burden and smoking prevalence ( P < 0.05). Outcomes compared favorably with national benchmarks, demonstrating lower PC, LOS, and RA. In perforated appendicitis, staged management showed a trend toward higher value compared with observation alone. Patients ≥50 years had higher rates of malignancy (3.9% vs 1.7%) and perforation (20.7% vs 7.1%; P < 0.05). Both age and perforation independently predicted malignancy. Conclusions High-value appendicitis care is driven by risk stratification and appropriate treatment selection. Older age and perforation identify patients at increased risk for adverse outcomes and malignancy, supporting tailored, pathway-based management strategies.