The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)

Paola Fugazzola, Marco Ceresoli, Vanni Agnoletti, Ferdinando Agresta, Bruno Amato, Paolo Carcoforo, Fausto Catena, Osvaldo Chiara, Massimo Chiarugi, Lorenzo Cobianchi, Federico Coccolini, Alessandro De Troia, Salomone Di Saverio, Andrea Fabbri, Carlo Feo, Francesco Gabrielli, Angela Gurrado, Angelo Guttadauro, Leonardo Leone, Daniele MarrelliLuca Petruzzelli, Nazario Portolani, Francesco Paolo Prete, Alessandro Puzziello, Massimo Sartelli, Giorgio Soliani, Mario Testini, Salvatore Tolone, Matteo Tomasoni, Gregorio Tugnoli, Pierluigi Viale, Monica Zese, Offir Ben Ishay, Yoram Kluger, Andrew Kirkpatrick, Luca Ansaloni

Research output: Contribution to journalReview articlepeer-review


The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.

Original languageEnglish
Article number19
JournalWorld Journal of Emergency Surgery
Issue number1
Publication statusPublished - Mar 10 2020


  • Appendectomy
  • Appendicitis
  • Elderly
  • Surgery in elderly

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine


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