Systemic Inflammatory Response Syndrome in Elderly Patients with Acute Appendicitis: Age-Related Immune Changes and Perioperative Management

Acute appendicitis is a common surgical issue with a lifetime risk of 7–8%. Prompt diagnosis is crucial to prevent complications, especially in elderly patients. Systemic Inflammatory Response Syndrome (SIRS) is a clinical condition characterized by widespread inflammation that can complicate appendicitis. This study examined the occurrence of SIRS across age groups, focusing on elderly patients, and assessed perioperative immune-modulating treatments. This retrospective study included 337 patients who underwent surgery for acute appendicitis. Patients were divided into four age categories: young adults (18–44 years), middle-aged adults (45–60 years), elderly (61–74 years), and senile (≥ 75 years). SIRS was identified using clinical criteria and examined in relation to patient age and type of appendicitis. Patients with SIRS (n = 207) received immunocorrective treatment, whereas the others received standard care. SIRS occurrence increased with age, from 32.3% in young adults to 100% in the senile group (p < 0.001). Elderly and senile patients met more SIRS criteria. SIRS was associated with appendicitis severity, reaching 100% in gangrenous peritonitis (p < 0.001). Patients with SIRS showed elevated inflammatory markers, including white blood cell count, C-reactive protein, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index. Immunocorrective treatment resulted in fewer complications (3.9%) than the typical rates for high-risk patients. This study showed an increase in SIRS incidence in elderly patients with acute appendicitis. The results revealed links between SIRS severity, age, and disease progression. The immunomodulatory protocol enhanced outcomes by reducing complications, particularly in elderly patients.