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EAES rapid guideline: appendicitis in the elderly

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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.

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Acknowledgements

The steering group would like to thank Mrs. Katie Gallagher and the European Patients Forum, and Mrs. Julia Wadoux and the AGE Platform Europe for assisting in identification of a patient representative for this guideline.

Funding

This project was funded by the European Association for Endoscopic Surgery. The funding body had no influence on the development of this guideline. There is no grant number linked to this research.

Author information

Authors and Affiliations

  1. Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus

    Stavros A. Antoniou

  2. Medical School, European University Cyprus, Nicosia, Cyprus

    Stavros A. Antoniou

  3. Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece

    Dimitris Mavridis & Katerina Maria Kontouli

  4. Faculté de Médecine, Université Paris Descartes, Paris, France

    Dimitris Mavridis

  5. 1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece

    Vasileios Drakopoulos

  6. Department of Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands

    Marguerite Gorter-Stam

  7. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden

    Sture Eriksson

  8. Department of Anesthesiology and Critical Care Medicine, Nord Hospital, Marseille, France

    Marc Leone

  9. Geriatrics Department, Hospital Universitari Vall D’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Maria Carmen Pérez-Bocanegra

  10. Department of Surgery, Department of Surgery, Royal Devon & Exeter Hospital, Exeter, UK

    Neil J. Smart

  11. Department of Clinical Medicine and Surgery, University “Federico II” of Naples, Naples, Italy

    Marco Milone

  12. PhD Program in Applied Medical-Surgical Sciences, University of Rome “Tor Vergata”, 00133, Rome, Italy

    Francesco Maria Carrano

  13. Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford, 81, 00133, Rome, Italy

    Francesco Maria Carrano

  14. Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK

    George A. Antoniou

  15. Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK

    George A. Antoniou

  16. Department of Health Management and Health Economics, University of Oslo, Oslo, Norway

    Per Olav Vandvik

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

Correspondence to Stavros A. Antoniou.

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Disclosures

Stavros A. Antoniou, Dimitris Mavridis, Katerina Maria Kontouli, Vasileios Drakopoulos, Marguerite Gorter-Stam, Sture Eriksson, Marc Leone, Maria Carmen Perez-Bocanegra, Neil J Smart, Marco Milone, Francesco Maria Carrano, George A Antoniou and Per Olav Vandvik have no conflicts of interest or financial ties to disclose. Detailed conflict of interest statements of all contributors can be found in https://osf.io/zhkum/.

Disclaimer

This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g., surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g., surgical nurses, dieticians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by health care authorities (e.g., regional and national authorities, health care institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management.

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Antoniou, S.A., Mavridis, D., Kontouli, K.M. et al. EAES rapid guideline: appendicitis in the elderly. Surg Endosc 35, 3233–3243 (2021). https://doi.org/10.1007/s00464-021-08524-9

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