Vol. 1 No. 2 (2026): AGE-RELATED DIFFERENCES IN SEVERITY, MANAGEMENT, AND OUTCOMES OF ACUTE APPENDICITIS: A BALKAN SINGLE-CENTER RETROSPECTIVE COHORT STUDY
Vol. 1, Issue No. 2 | July 2026
Acute appendicitis remains one of the most common surgical emergencies worldwide, yet its presentation and outcomes differ significantly with age. Older adults often present with atypical symptoms, delayed diagnosis, and a higher risk of perforation and postoperative complications. Understanding these age-related differences is essential for improving emergency surgical care and reducing adverse outcomes.
This original research article in the Journal of the European Society of Surgery (JESS) presents a retrospective cohort study of 261 patients who underwent appendectomy at a tertiary surgical center in North Macedonia between January 2024 and December 2025. Patients were grouped into those younger than 60 years and those aged 60 years or older. The study evaluated disease severity, diagnostic imaging, surgical approach, postoperative complications, hospital stay, and predictors of complicated appendicitis. The findings revealed that older patients had significantly higher rates of complicated appendicitis, greater use of CT imaging, lower rates of laparoscopic surgery, increased postoperative morbidity, and longer hospital stays. Multivariable analysis identified age ≥60 years as the strongest independent predictor of complicated appendicitis, followed by the presence of comorbidities.
The study concludes that older adults with suspected acute appendicitis require earlier diagnostic imaging, careful perioperative assessment, and timely surgical intervention to reduce complications. While laparoscopic appendectomy should remain the preferred approach whenever technically feasible, clinicians should recognize that elderly patients frequently present with more advanced disease requiring individualized management strategies. These findings provide valuable evidence for general surgeons, emergency physicians, surgical trainees, and healthcare professionals involved in the management of acute abdominal emergencies and geriatric surgical care.
