Non-operative Management of Uncomplicated Appendicitis in Older Adults: Current Evidence and Limitations

Abstract

Background
In the setting of acute appendicitis, while operative management (OM) remains standard, non-operative management (NOM) with antibiotics is an alternative, especially in geriatric population. However, evidence in this population is limited.
Purpose
This scoping review explored the efficacy and safety of NOM compared with OM for acute, uncomplicated appendicitis in geriatric patients (≥65 years), identified gaps in the literature and proposed evidence-informed recommendations to guide future research.

Methods
Following PRISMA-ScR guidelines, we applied the PCC framework for criteria definition. PubMed and Embase were searched, and Covidence facilitated study selection. Within predefined timeframes, primary outcome is post-treatment complication and secondary outcomes are treatment success, readmission, and hospital stay. Risk of bias was assessed using the Newcastle–Ottawa Scale.

Results
Of 770 records screened, four studies met the inclusion criteria. Sample sizes ranged from 2,640 to 474,845 patients. Reported complication rates for NOM were about 18.0%, compared with 10.8% for OM. NOM success rates varied from 62% to 82%. Hospital stays were more extended with NOM, ranging from 4 to 7 days. Reporting of antibiotic protocol was substantially missing. Frailty was frequently identified as a significant modifier of outcomes.

Conclusions
Current evidence on NOM in the geriatric population is substantially lacking. Frailty significantly modifies risks and benefits: while NOM was generally associated with higher complication rates and more extended hospital stays, it also achieved relatively high success rates. To ensure a quality comparison between NOM and OM, future studies should include stratification by frailty, detailed antibiotic protocols, and well-defined outcomes.