by 
Antoniou SA, Mavridis D, Kontouli KM, Drakopoulos V, Gorter-Stam M, Eriksson S, et al. EAES rapid guideline: appendicitis in the elderly. Surg Endosc 2021;35:3233–43. doi:10.1007/s00464-021-08524-9.
Inclusion/Exclusion
The overarching inclusion criterion was patient age ≥ 65 years. Exclusion criteria were robotic surgery, natural orifice transluminal endoscopic surgery, and single-incision laparoscopic surgery.
Recommendations
We suggest against the use of Alvarado score or RIPASA score compared with computed tomography (CT) scan for the diagnosis of acute appendicitis in elderly patients.
Weak recommendation.
We suggest against the use of antibiotics over appendectomy in elderly patients who are deemed fit for surgery.
Weak recommendation.
We suggest laparoscopic over open appendectomy in elderly patients.
Weak recommendation.
Risk of appendectomy in elderly patients
Available evidence, which is of low certainty, suggests that the risk of death after appendectomy in elderly patients is estimated at 1%, the risk of major complications at 6% (95% confidence interval, CI 4–8), the risk of minor complications at 8% (95% CI 5–13) and duration of hospital stay is usually between 4 and 8 days. The above figures depend on patient status and comorbidities, and stage of the disease.
Risks of laparoscopic appendectomy in elderly patients
Available evidence, which is of low certainty, suggests that the risk of death after laparoscopic appendectomy in elderly patients is estimated at 1%, the risk of major complications at 5% (95% CI, 3 to 7), the risk of minor complications at 4% (95%, CI 4 to 5) and duration of hospital stay is usually between 4 and 6 days. The above figures depend on patient status and comorbidities, and stage of the disease.
Risks of open appendectomy in elderly patients
Available evidence, which is of low or very low certainty, suggests that the risk of death after appendectomy in elderly patients is estimated at 2%, the risk of major complications at 5% (95% CI 1–17), the risk of minor complications at 5% (95% CI 1–24) and duration of hospital stay is usually between 6 and 9 days. The above figures depend on patient status and comorbidities, and stage of the disease.